Obstructive Sleep Apnea (OSA)

If your child snores or has trouble breathing at night, he or she may not just be a noisy sleeper. It could be a sign of obstructive sleep apnea (OSA), a condition in which breathing is repeatedly blocked during sleep. OSA affects about 2 to 5 percent of children and teenagers.

OSA occurs when the upper airway in the back of the nose or throat is blocked, preventing the normal amount of air from entering the lungs. Sleep apnea involves brief (10- to 20-second) breathing pauses (apneas) that occur often throughout the night. These pauses can lead to a temporary decrease in oxygen levels, which alert the brain there is a problem. The brain then “jump starts” breathing again by waking up the sleeping person. Although breathing resumes, these brief wakings disrupt sleep.

OSA can cause children to be tired, irritable, or hyperactive during the day and to perform below their potential at school.

The symptoms of obstructive sleep apnea (OSA) are sometimes difficult to detect in children. Children with OSA may not look sleepy, even if they’re not sleeping well. Symptoms of OSA can also vary depending on the child and the severity of the problem.

Common symptoms may include:

• Snoring
• Breathing pauses during sleep that last about 10 to 20 seconds and often end in a gasp, snore, snort, or sigh
• Sleeping with the mouth open or neck extended
• Restless sleep
• Waking often during the night
• Sweating during sleep
• Tiredness, moodiness, irritability, or hyperactivity during the day
• Difficulty waking in the morning
• Dry mouth or headaches in the morning
• Nighttime bed wetting that returns after months or years of the child being dry at night

If you think your child might have OSA, talk with your primary care provider. He or she may refer you to a sleep specialist for a full evaluation and sleep study.

OSA is caused by a blockage of the upper airway in the back of the throat. Common reasons for the blockage include:

• Enlargement of the tonsils and adenoids (spongy tissues at the back of the throat)
• Fat deposits around the upper airway due to being overweight or obese
• Allergies, asthma, sinus infections, or gastroesophageal reflux
• Certain medical conditions, such as Down syndrome and Prader-Willi syndrome
• Craniofacial conditions such as Pierre Robin sequence, Apert syndrome, and Crouzon syndrome
• Neuromuscular disorders that affect muscle tone and function, such as muscular dystrophy and cerebral palsy

To help diagnose your child’s condition, the clinician will take a detailed medical history and perform a full physical examination. He or she may also:

• Ask questions about your child’s breathing during sleep and any other symptoms he or she is having
• Ask you to take a video or keep a sleep log. A sleep log tracks how many hours your child sleeps, how many times he or she wakes up, and his or her level of alertness in the morning. A short video of your child sleeping taken on your cell phone can also be very helpful to document your child’s symptoms. If you have already have these, be sure to bring them to your appointment.

• An X-ray of your child’s upper airway
• A polysomnogram (sleep study) to measure different types of data and record sleep stages, breathing, oxygen levels, heart rate, body movements, and sleep disruptions

Getting care for obstructive sleep apnea can have far-reaching positive effects on your child’s overall health.

If your child has been diagnosed with OSA, there are many effective treatments. These may include:

• Weight loss for children who are overweight
• Nasal steroids and other medications to reduce nasal congestion, particularly in children who have allergies or asthma
• Oral (dental) appliances to open the airway
• Using a continuous or bi-level positive airway pressure (CPAP or BiPAP) machine to keep the airway open during sleep
• Muscle retraining of the upper airway (myofunctional therapy)
• Surgery to remove the tonsils or adenoids (tonsillectomy or adenoidectomy) or to correct any abnormalities in facial structure

At Boston Children’s Hospital, the specialists in our Sleep Center include a team of board-certified clinicians with training in pulmonary medicine, neurology, developmental medicine, otolaryngology (ear, nose, and throat, or ENT), and dentistry. Children whose sleep apnea is caused by enlargement of their adenoids and tonsils are also treated in the Department of Otolaryngology and Communication Enhancement.