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MY CHILD SNORES ALL THE TIME; SHOULD I BE CONCERNED? HOW DO I KNOW IF MY CHILD HAS
A SLEEP DISORDER? DOES MY CHILD NEED A SLEEP
STUDY? MY CHILD SNORES ALL THE
TIME; SHOULD I BE CONCERNED? Sleep
disorders and sleep-associated breathing problems are being recognized
more often by doctors as a significant health problem in children. Sleep
apnea is part of a spectrum of obstructive sleep disorders. Sleep apnea is
manifested by repeated episodes of decreased breathing during sleep due to
problems in the upper part of your child's airway, that is the area above
the main windpipe. To
maintain good air movement through the partially obstructed airway, the
child must increase his effort at breathing. However, when the effort of
breathing reaches a certain point, it actually worsens the obstruction.
During sleep, a repeating cycle occurs where airflow through the
obstructed airway totally stops. These pauses in breathing are called
apnea episodes. Apnea
is defined as complete absence of airflow for 10 seconds in adults and 6
seconds in children. Apnea results in low levels of oxygen in the body,
higher acid levels in the blood vessels, and extra carbon dioxide gas
which is supposed to be blown away when your child breathes. When the
levels of acid, oxygen and carbon dioxide reach certain levels in the
blood vessels, warnings are sent to the brain to stimulate more normal
breathing by arousal or awakening. This
repeating cycle of sleep awakenings and restless sleep may occur many
times a night. The length of time and number of times apnea episodes occur
vary according to your child's ability to tolerate and compensate to the
changes in oxygen, carbon dioxide and acid levels. Some
of the many long-term effects, which are directly related to the new
levels of oxygen, carbon dioxide and acid, include: 1.
Decreased heart rate, extra heart beats, or abnormal
heart beat patterns: These responses have been associated with
"unexplained" deaths while sleeping and the sudden infant death
syndrome also known as SIDS. 2. Tightening of blood vessels within the lungs: These tightened blood vessels make it harder for the lungs to deliver more oxygen and remove carbon dioxide, making the entire problem worse. It makes it harder for the heart to pump fresh blood into the lungs. The heart has to work harder which results in enlargement of the right side of the heart. This change in the heart and lungs is called corpulmonale and can eventually lead to heart failure. Enlarged
tonsils and adenoids are the most common cause of obstruction of the upper
part of the airway during sleep in children. Other causes include
narrowing of the nasal passageways, enlarged tongue, small lower jaw which
pushes the tongue backwards, birth defects which alter the development of
the bones of the face, cerebral palsy, Down syndrome, narrowing of the
voice box, paralysis of the voice box, and simply being an overweight
child. Newborn
babies and young infants represent a special group of patients with sleep
disorders. These children have not fully developed the normal responses to
changes in oxygen, carbon dioxide and acid levels in the blood stream. The
warning system to alert the brain of these changes is also immature.
Therefore, sleep disorders in newborns and young infants may be more
severe than those seen in older children.
HOW DO I KNOW IF MY
CHILD HAS A SLEEPING DISORDER? The
evaluation of a child with possible sleep apnea is complex. Many of the
signs and symptoms, which occur at night, are not witnessed by parents and
sometimes are only subtle during the day. Since the disorder is chronic,
the child gets used to some of the symptoms and begins to associate these
with his normal healthy state. Because the changes slowly occur, many
parents are unable to recognize the changes. Some
children alter their growth rates as a means of compensation. Important
information need includes the length of time the snoring has been present
and if is has become more severe over time.
The severity of the snoring alone does not necessarily equal the
severity of the obstruction. Some loud snorers have constant, rhythmic
breathing cycles, while some quiet snorers have prolonged periods of
apnea. You may even be aware of episodes where your child gasps for air.
This is common after an episode of apnea. Other
common symptoms of sleep apnea can be divided into those present at night
and those which occur during the day. Daytime symptoms include mouth-breathing,
excessive sleepiness, poor school performance, hyperactivity, short
attention span, excessive aggressiveness, weight problems (overweight and
underweight), frequent colds, chronic runny nose, choking on food,
difficulty swallowing food, abnormal speech. Nighttime symptoms include
snoring, pauses in breathing, frequent awakening from sleep, nightmares,
excessive sweating, and bedwetting. Children
with obstructive sleep disorders may be classified into four groups based
upon the severity of the symptoms:
*
Class I: Snoring alone-noisy breathing but breaths are orderly and
regular
*
Class II: Snoring with irregular breathing cycles with pauses up to
5 seconds, pauses are well spaced apart
*
Class III: Snoring with pauses in breathing less than 6 seconds, or
frequent short pauses of 3 seconds or more.
*
Class IV: Obstructive sleep apnea-snoring with pauses greater than
6 seconds, 20-30 episodes of apnea per night, behavioral changes, daytime
sleepiness and poor school performance, poor growth and development, heart
failure. DOES MY CHILD NEED A
SLEEP STUDY? A
frequently used, inexpensive study is the nighttime recording of your
child's sleep using an audiocassette tape recorder. This tape provides
information regarding sleep sounds such as snoring, pauses, gasping,
choking and coughing episodes. Some families have made video recordings,
which document the sounds and the associated abnormal sleep movements and
behaviors. The
sleep study is the most accurate way to diagnose sleep apnea.
The sleep study can monitor oxygen and carbon dioxide levels, brain
waves, heart rate, amount of air flowing through the nose and mouth,
amount of effort the chest muscles use to breathe, and the amount of acid
from the stomach which travels to the upper airway.
The frequency and length of apnea episodes is well documented by
the sleep study, but more importantly, the type of apnea is determined. Although
the sleep study is extremely useful, it is very expensive and often
requires sleeping overnight in the hospital or sleep lab which performs
the study. Sleep
studies are not practical in the routine evaluation of the snoring child.
It is best reserved for a child who is strongly suspected of having sleep
apnea but whose history and examination do not clearly support the
diagnosis, or in children with significant brain disorders to distinguish
between central and obstructive apnea. There
are many treatment options available for children with obstructive sleep
apnea. The options basically fall into the categories of non-surgical and
surgical. The non-surgical therapies include medications which may
stimulate the brain to increase breathing, weight loss, placing a flexible
tube through the nose to by-pass the obstruction, creating a dental
appliance which moves structures to improve airflow, and a machine which
delivers a continuous stream of pressured air into the nose or mouth.
These treatments are for specific patients but remain mostly ineffective
in the treatment of most children. In
general, surgery remains the mainstay of treatment for obstructive sleep
apnea in children. The surgical therapies are directed toward removing the
obstruction or bypassing the obstruction. Since adenoid and tonsil
enlargement is by far the most common cause of sleep apnea in children, an
adenoidectomy and tonsillectomy are the most commonly performed surgeries.
Although
tonsillectomy and adenoidectomy in obstructive sleep apnea patients is
technically the same procedure as when it is performed for recurrent
infections, the immediate 24 hours after surgery is extremely critical.
These patients should be monitored overnight in the hospital, often they
are observed in an intensive care unit.
Other surgical procedures include trimming the soft palate,
reducing an enlarged tongue, and nose surgery to remove the obstructing
tissue. The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment. |
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