Sleep Apnea

Obstructive sleep apnea occurs when a child stops breathing during periods of sleep. This usually occurs because of a blockage in the airway, such as enlarged tonsils and adenoids or inflamed and infected glands.

At the CHOC Sleep Center, we specialize in diagnosing children with sleep apnea. Our comprehensive sleep studies evaluate breathing, brain activity, heart activity, oxygen content in the blood, chest and abdominal wall movement, muscle activity and the amount of air flowing through the nose and mouth. A technologist will intervene anytime an issue arises, including episodes of apnea. Sleep apnea is generally considered significant in children if more than 10 apnea episodes occur per night, or one or more occur per hour.

What causes sleep apnea?

Sleep apnea is most commonly found in children between three to six years of age. It can occur in children with large tonsils and adenoids, which can make it difficult to breathe during sleep. It also occurs in children with congenital conditions affecting the upper airway (for example, conditions causing large tongue or small jaw) and in children whose brain doesn’t send proper signals to the muscles that control breathing. Obesity may also cause obstructive sleep apnea, though obesity is a far less common reason in children than in adults. Certain syndromes or birth defects, such as Down syndrome and Pierre Robin syndrome, can also cause obstructive sleep apnea.

What are the symptoms of sleep apnea?

The following are the most common symptoms of obstructive sleep apnea. However, each child may experience symptoms differently. Symptoms may include:

  • Loud snoring or noisy breathing during sleep.
  • Periods of not breathing. Although the chest wall is moving, no air or oxygen is moving through the nose and mouth into the lungs. The duration of these periods is variable and measured in seconds.
  • Mouth breathing. No air is moving from the nose to the throat, requiring a child to breathe through the mouth.
  • Restlessness during sleep. This occurs with or without periods of being awake.
  • Excessive daytime sleepiness or irritability. Because the quality of sleep is poor, the child may be sleepy or irritable in the daytime.
  • Hyperactivity during the day.
  • Excessive sweat during sleep or bedwetting.

How is sleep apnea treated?

It is important to treat sleep apnea as soon as possible. Sometimes, sleep apnea can cause lowered blood oxygen levels, which could lead to long-term effects.

The treatment for sleep apnea is based on the cause. Since enlarged tonsils and adenoids are the most common cause of airway blockage in children, treatment may include evaluation by a pediatric ear, nose and throat physician and possible surgery to remove the tonsils and/or adenoids.

If the cause of the disorder is obesity, less invasive treatments may be appropriate, including weight loss and wearing a CPAP or BIPAP mask while sleeping to keep the airway open. This mask uses air pressure to force the airway open, acting like a splint. Our technologists will work closely with you and your child to learn how to properly use a mask and adapt your lifestyle to it.

Children and Snoring

In this segment of American Health Journal, Dr. Paul Lubinsky, associate director of the PICU at CHOC, explains the reasons why children snore and the treatments that are available.