Snoring and Sleep Apnea in Children

July 10, 2007

As discussed in Snoring from A to ZZZZ By Derek S. Lipman, M.D.

Snoring:

A snoring child is frequently a source of alarm to parents - and an annoyance to a brother or sister sharing the bedroom. As in adults, snoring in childhood signals an obstruction in the breathing passages of the nose or throat. And, as we have seen in adults, loud habitual snoring in children may progress to frank obstructive sleep apnea.

Anatomical obstruction in the upper airway from enlarged tonsils and adenoids is among the most common causes of snoring and apnea in children. Chronic nasal obstruction (from allergy or infection) can also contribute to their obstructed breathing.

Sleep Apnea:

Sleep Apnea frequently has a profound effect on the quality of a child's life, influencing personality, behavior, mood, learning ability and general physical development. Parents often describer these children as restless sleepers who are difficult to arouse, being disoriented and confused when awakened. Changes in the intellectual ability of these children are common - attention lapses and inability to concentrate - for which they might be punished because of the behavior, is mistakenly regarded as day-dreaming or indifference. Older children, who have the ability to describe their symptoms, will sometimes voluntarily complain of morning headaches.

Unlike their adult counterparts, snoring children with disturbed sleep are usually not overweight. On the contrary, they tend to be thin and below their expected height and weight. These children may also be bed-wetters - usually due to a reduction in muscle tone as a child drifts into deep levels of sleep after numerous awakenings.

A review at Standford University Medical School of 100 children with confirmed sleep apnea sheds light on the wide variety of problems this condition introduces into a child's life. Seventy-three of these children had excessive daytime sleepiness noted by parents and teachers; more than half of this group had nightmares or night terrors. Seventeen described morning headaches; 58 showed failure to thrive, being markedly underweight for their age. In the older children studied, sleepiness, fatigue and tiredness were apparent.

Special testing identified many with delayed language acquisition and decreased school performance. At least half of this group had frequent coughs and colds; all demonstrated heavy habitual snoring - the hallmark of obstructive sleep apnea. Other noted features of their behavior at night included bed-wetting, sleep-walking, profuse sweating and restless sleep, with frequent awakenings.

The ADHD Epidemic:

We have seen a dramatic increase in the incidence of attention deficit disorders during the past decade. Since 1990, the number of children diagnosed with ADHD has risen disturbingly from approximately 800,000 to almost 4 million. This suggests a problem of almost epidemic proportions. ADHD appears to be more common in boys; 1994 data estimates that 5 per­cent of boys and 1.5 percent of girls had been labeled as having attention deficit by their physicians.

The most widely prescribed treatment for ADHD is Ritalin, an amphetamine derivative, hence a stimulant. The rapidly increasing frequency with which the diagnosis of ADHD is made has produced a concomitant increase in Ritalin prescription and usage. In fact, since 1991, there has been a 700 percent increase in Ritalin prescriptions of children of school-going age.

A closer look at many comparable aspects of ADHD and sleep-disordered breathing in childhood (obstructive sleep apnea and the upper airway resistance syndrome) reveals a disturbingly high number of shared symptoms. Parents frequently voice concern about their hyperactive child's insomnia and restless sleep; researchers studying ADHD have often considered these features to be results of the underlying behavior disorder (or its treatment) rather than a contributory cause.

Recent studies by Ronald Chervin, M.D. at the University of Michigan show a link between inattention, hyperactivity and sleepdisordered breathing. Habitual snoring was found in 33 percent of children diagnosed with ADHD, but only in 10 percent of children in compara­tive groups. Similarly, snoring and excess daytime sleepiness were associated with higher levels of inattention and hyperactivity.

Data from this research suggests that by control of sleep­related breathing disturbance, establishing normal sleep patterns, ADHD could be eliminated in a large percent­age of those children with attention deficit and habitual snoring

Clearly, further research is needed to shed light on this ubiquitous childhood medical problem, having such a serious social and economic impact on millions of families nationwide. And pediatric residency training programs across the United States are now emphasizing the pos­sible existence of a sleep disorder as the underlying cause of any child's deficiencies in general health, development or performance.

When to Suspect Sleep Apnea in Childhood

While Asleep

• Loud snoring, punctuated with recurring periods of silence.
• Constant mouth-breathing with restless sleeping.
• disturbed sleep - restless movements movements, unusual , frequent awakenings.
• Extreme thirst during the night.
• Bad dreams and nightmares.
• Difficult to arouse.
• Bed-wetting (enuresis).

While Awake

• Lethargic and slow to get going on awakening.
• Developmental delay, poor concentration, inattention and moodiness.
• Excess daytime sleepiness.
• Morning headaches.
• Constant mouth breathing.
• Slow eating with poor appetite.
• Thin and underweight for age.
• Dry mouth and bad breath on awakening.

For more information on snoring and sleep apnea in children, read Snoring from A to ZZZZ.

Used with permission by: Derek S. Lipman, M.D.

Derek S. Lipman, M.D., is an ear, nose and throat specialist in Portland , Oregon. He received his M.D. at the University of Cape Town Medical School, completing internship amd residency at the same institution. He and his family immigrated to the USA in 1977. On the active staff of several major Portland hospitals, Dr. Lipman's practice is devoted to the treatment of snoring and sleep-related breathing disorders. Dr. Lipman belongs to county, state, and national medical associations including the American Sleep Apnea Association, where he served on the Public Education and Communication Committee.

Dr. Lipman is the author of Snoring From A to ZZZZ: Proven Cures for the Night's Worst Nuisance, a widely-acclaimed book, now published in seven foreign languages.

His website can be found at www.drlipman.net.