Sunday, May 26, 2024

Central Sleep Apnea In Toddlers

Continuous Positive Airway Pressure Therapy

What parents need to know about sleep apnea in children

When sleep apnea is severe or doesnt improve with initial treatment, your child may need continuous positive airway pressure therapy.

During CPAP therapy, your child will wear a mask that covers their nose and mouth while they sleep. The mask is connected to a CPAP machine, which provides a continuous flow of air to keep their airway open.

CPAP can help the symptoms of obstructive sleep apnea, but it cant cure them. The biggest problem with CPAP is that children frequently dont like wearing a bulky face mask every night, so they stop using it.

How To Tell If Your Baby Has Sleep Apnea

There are several signs a parent can look for when their child is sleeping to determine if they might have sleep apnea. The first thing theyll want to do is listen to the infants breathing. If your child routinely pauses for breaths, gasps for air, chokes, has noisy breathing or snorts you should let your health care provider know. You should also be concerned if you hear what sounds like snoring and you hear it persistently night after night. Its not uncommon for little ones to cry and to squirm in their bed, but infants dont snore.

Another important thing to note is that if a child has sleep apnea, theyll also have difficulty breathing while taking naps during the day too. Sleep apnea isnt exclusive to night time sleeping only.

Descriptive Analysis Of Subjects

Four hundred and eighty seven children met the criteria for final analysis, among which 338 were boys. Both genders did not differ in mean age, proportions of each age group and weight group, and percentage of adenotonsillar hypertrophy . Overall, their ages ranged from 1.2617.96 years. Sixty-five cases had a CAI1h1, whereas 2 cases had a CAI > 5h1. The CAI was 010h1 with a mean of 0.46±0.85h1.

Table 1 Demographic characteristics of children with sleep-disordered breathing

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American Sleep Apnea Association

We envision a world in which most people suffering from sleep apnea are diagnosed, aware, educated and treated. This serious syndrome, when left untreated has a large influence on quality of life and multiple life-threatening implications. Yet it is highly treatable. Unfortunately it is estimated that more than 80% of people suffering from sleep apnea are undiagnosed. To help those living with sleep apnea, we work relentlessly to promote

  • better awareness in the general public and among health professionals and,
  • affordable, convenient and highly effective diagnoses and treatments.
  • Central Sleep Apnea Symptoms

    Central Sleep Apnea in Children

    The main symptom of CSA is pauses in breathing. It usually doesnt cause snoring, the way obstructive sleep apnea does.

    Symptoms also include:

    • Being very tired during the day
    • Waking up often during the night
    • Having headaches in the early morning
    • Trouble concentrating
    • Not being able to exercise as much as usual

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    Diagnosis Of Obstructive Sleep Apnea In Children

    • Polysomnography with oximetry and end-tidal carbon dioxide monitoring

    Obstructive sleep apnea is considered in children with snoring or risk factors. If symptoms of OSA are present, diagnostic testing is done in a sleep laboratory using overnight polysomnography Testing Almost half of all people in the US report sleep-related problems. Disordered sleep can cause emotional disturbance, memory difficulty, poor motor skills, decreased work efficiency, and increased… read more that includes oximetry and end-tidal carbon dioxide monitoring. Polysomnographic criteria for diagnosis is lower than for adults. Home polysomnography is under evaluation.

    Polysomnography can help confirm the diagnosis of obstructive sleep apnea, but diagnosis also requires that the child not have a cardiac or pulmonary disorder that could explain the polysomnographic abnormalities. Analysis of sleep stage and the effects of position during polysomnography can help indicate the contribution of upper airway obstruction. Thus, results of polysomnography can help determine initial treatment .

    Patients with OSA are evaluated with other tests based on clinical judgment. Other testing may include ECG, chest x-ray, arterial blood gas measurement, and imaging of the upper airway.

    What Are The Signs Of Central Sleep Apnea

    Signs of central sleep apnea occur when your child is transitioning in or out of sleep or after a temporary change in brain activity levels during sleep. Some of these signs may be due to obstructive sleep apnea.

    These signs can include:

    • a pause in breathing followed by loud gasping with return to normal breathing pattern
    • difficulty staying asleep
    • snoring with extra effort to breathe during sleep
    • waking up feeling short of breath

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    What Is Obstructive Sleep Apnea

    Obstructive sleep apnea is a condition in which there are brief pauses in your child’s breathing pattern during sleep. Breathing usually stops because there is a blockage or an “obstruction” in the airway. OSA occurs in up to 2%-5% of children and can occur at any age. It is most commonly seen in children between the ages of 2 and 6 years old.

    Sleep apnea results in many brief awakenings from sleep when the brain senses changes in the oxygen or carbon dioxide in the body and send signals to the lungs to try to get a breath in. These awakenings are brief and sleep resumes right after. To put it differently, it is like hearing the telephone ring once in your sleep and then stop. You may not even get up to reach for the phone but your sleep is interrupted briefly. Now imagine this happening over and over again throughout the night! Although your child may not be aware he or she is waking up, these interruptions in sleep can lead to daytime problems.

    What Are The Causes Of Pediatric Sleep

    What are the signs of sleep apnea in children?

    Obstructive sleep apnea may happen because something is blocking the upper airway, such as enlarged tonsils or adenoids. It may also happen if the muscles in the back of the throat relax and collapse during sleep.

    Infants are more at risk for obstructive sleep apnea due to their tendency to put items in their mouth and their smaller, and sometimes underdeveloped, airways.

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    What Causes Obstructive Sleep Apnea In Children

    There are several causes of obstructive sleep apnea in children:

    • Enlarged tonsils and adenoids: A widely recognized risk factor for childhood OSA is enlarged tonsils and adenoids. Tonsils and adenoids are glands located at the back of the throat and are part of the immune system. The tonsils and adenoids may be enlarged due to genetics, frequent infections, or inflammation. When enlarged, these glands constrict the airway, making breathing during sleep more difficult.
    • Childhood obesity: OSA in children is also frequently caused by obesity, which also constricts the airway. Obstructive sleep apnea occurs in 60% of obese children.
    • Other risk factors: Other causes of OSA include having a small jaw or an overbite, the use of sedatives or opioids, and tongue and throat muscle weakness due to conditions like Down syndrome or cerebral palsy. Having nasal allergies, being around adults who smoke, and having a family history of obstructive sleep apnea are also found to be risk factors for childhood OSA.

    How Is Central Sleep Apnea Different From Obstructive Sleep Apnea

    In obstructive sleep apnea, a person makes a notable effort to breathe, but the airway in the back of the throat is blocked. The blockage in the back of the throat causes an obstruction to our windpipe, which leads to sleep fragmentation and a disturbed oxygen balance in the body.

    In central sleep apnea, the problem isnt a blocked airway. Instead, pauses in breathing occur because the brain and the muscles that control breathing arent functioning properly. As a result, there is no normal respiratory effort, which is in clear contrast to OSA.

    While OSA and CSA are separate conditions, they can arise at the same time in what is known as mixed sleep apnea. In addition, treatment of OSA with continuous positive airway pressure , can induce central sleep apnea, and this is called treatment-emergent central sleep apnea.

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    How Is Obstructive Sleep Apnea Treated

    Sleep apnea is treated in one of four general ways, depending on the cause of the obstruction. Treatment options include:

    • Surgery: Removal of enlarged tonsils and adenoids . Other types of surgeries may be needed in children with structural abnormalities of their head and neck area. For example, a dental or facial surgeon may be able to adjust the position of poorly aligned teeth or the small jaw and thus create more room in the airway.
    • Lifestyle modification: Weight loss may be helpful in the management of OSA in overweight children.
    • Medications: Medications may sometimes be helpful in keeping airways clear or opening airways. Examples of such medications include fluticasone and montelukast .
    • Continuous positive airway pressure : CPAP involves wearing a mask over the nose during sleep. The mask is attached to a small portable machine that blows air through the nasal passages and into the airway. The air pressure generated by the machine keeps your child’s airway splinted open and allows him or her to breathe normally during sleep.

    Diagnosing Sleep Apnea In Children

    Would a Child with Sleep Apnea Need CPAP?

    Children are more difficult to diagnose than adults, and can easily be misdiagnosed by doctors. If you think that your child has a sleep disorder, visit an accredited sleep center for a sleep study.

    Some of the sleep apnea symptoms differ in children and adults with sleep apnea. The children with sleep apnea are hyperactive or aggressive. They are not necessarily sleepy as adults with sleep apnea.

    Therefore it would be wise to look for a sleep specialist who is experienced with pediatric sleep apnea and other sleep disorders.

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    Symptoms In Children Older Than 1 Year

    • Behavioral and attention problems
    • Breathing that stops for a few seconds at a time during sleep
    • Breathing through the mouth only
    • Difficult to wake in the morning
    • Gasping noises during sleep
    • Irritability from lack of quality sleep
    • Loud breathing during sleep

    *Age of infants as defined by the World Health Organization

    Diagnoses Of Sleep Apnea In Children

    It is important to see a doctor immediately if you suspect that your child may have sleep apnea. Your childs pediatrician may send your child to a sleep specialist for a physical exam and a sleep study. For a sleep study, your child would spend one night at a hospital or a sleep clinic. Before the sleep study, a sleep technician will place sensors on your childs body to monitor the following during sleep:

    • Breathing patterns.
    • Brain waves.
    • Muscle activity.

    Some doctors may not feel like a child needs a full sleep study and will issue an oximetry test instead. This is simply monitoring the childs heart rate and the amount of oxygen in the blood while sleeping. This test will indicate whether a full sleep study is needed for the child.

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    What Is Central Sleep Apnea

    Sleep apnea is when something interrupts your breathing for several seconds at a time as you sleep.

    The most common type, obstructive sleep apnea , is a problem with the mechanics of breathing. Something — like extra body weight or loose skin — causes the airway between your nose and your lungs to close and block airflow for a few moments when you sleep.

    In central sleep apnea , there is no mechanical problem. Your brain simply doesnât signal your muscles properly, so you stop breathing briefly or breathe so lightly that you donât get enough oxygen.

    Doctors donât know exactly how many kids have CSA. But between 1% and 5% of all kids have some type of sleep apnea.

    What Are The Symptoms Of Sleep Apnea

    Sleep Apnea in Children

    Snoring is a hallmark symptom of obstructive sleep apnea. However, not all children who snore have sleep apnea, and not all children with sleep apnea snore. Only a doctor can determine whether a childâs symptoms are due to sleep apnea.

    In addition to snoring, other symptoms of sleep apnea in children during sleep include:

    • Breathing through the mouth during sleep
    • Coughing or choking

    Sleep apnea also causes detrimental symptoms during waking hours. These may include:

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    How To Diagnose And Treat Sleep Apnea In Children

    Sleep apnea in children, infants and toddlers is more common today than it was in any other generation.

    Obesity, large tonsils or adenoids, a narrow upper airway, may trigger obstructive sleep apnea in kids.

    If you hear your child snoring in his sleep, look inside his mouth for his tonsils or adenoids. Does he have swollen tonsils? Enlarged tonsils or adenoids are the main causes of sleep apnea in children.

    Although tonsillectomy and adenoidectomy are the best treatments for pediatric sleep apnea, they are ineffective in curing 30% of the children.

    How To Treat Infant Sleep Apnea

    Infants with sleep apnea may receive oxygen supplementation or need a machine to provide breathing support. They also may need treatment with medications. All of these options tend to be short-term treatments.

    Infant sleep apnea tends to go away as the child grows and matures. Ninety-eight percent of preterm infants will be free of symptoms by 40 weeks after conception. The problem is more likely to persist longer in infants who were born less than 28 weeks after conception.

    Any medical condition that causes infant sleep apnea or makes it worse also needs to be treated. Surgery to correct airway abnormalities may be indicated in some instances. The treatment will depend on the nature of the medical problem.

    Long-term complications are rare for most children with infant sleep apnea. Problems are more likely for infants who need frequent resuscitation. Health problems also are more common if the infant sleep apnea is related to another severe medical condition.

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    Healthy Kids Sleep Needs Healthy Teeth Jaw And Airways

    The evidence is mounting on the importance of breathing for healthy kids development. Sleep apnea symptoms have close links to a decrease in brain development in kids.

    Like adult sleep disorders, diagnosis in kids is difficult. A high number of sleep disorders, dont test positive for OSA.

    The number of kids with upper airway resistance syndrome is not well understood.

    Having A Child With Sleep Apnea

    Sleep Apnea in Kids: Recognising the Symptoms

    I remember a three-year-old Ann’s mom, Angela, who was full of anxiety about her child.

    She taken her to sleep in the same bed with her, in case she needed to wake her up to start breathing again. She was really worried.

    Note:Since a child is unaware of his breathing problems in the night, a parent’s effort to help his child is crucial!

    There are parents who don’t realize that their child has a sleep disorder.

    It’s so funny when my child snores…said a parent. Well, when a child snores, something is not right.

    Snoring is the most obvious symptom of OSA in children.

    So, if you hear your child snoring, don’t laugh but be careful at his sleep. Heavy snoring with loud snorting is a sign of severe obstructive sleep apnea.

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    Treatments For Pediatric Sleep Apnea

    According to the Korean Journal of Pediatrics, one of the most common treatments for Sleep Apnea in children is the removal of the tonsils and adenoids if they are enlarged. If your pediatrician feels like your childs Sleep Apnea may be caused by enlarged tonsils or adenoids, you may be referred to an ear, nose, and throat doctor . Your child may need an adenotonsillectomy to remove both the tonsils and adenoids, and for many children, this resolves the problem.

    When the adenoids and tonsils arent the cause of Sleep Apnea or the symptoms remain after your childs adenotonsillectomy, then continuous positive airway pressure therapy may be recommended for your child. CPAP therapy involves wearing a mask that covers the mouth and nose while your child is sleeping. The mask is connected to a CPAP machine, which continuously pumps air to keep airways open and deliver air to the lungs. Since children and toddlers have smaller heads than adults, its important to get a pediatric CPAP mask specifically designed for the needs and comfort of a child.

    If being overweight is a factor in your childs Sleep Apnea, it will be important to work with your doctor on safe weight loss methods for your child, including exercise and dietary changes. If your childs Sleep Apnea is mild, weight loss may eliminate the problem and your child may not need further treatment.

    Other treatments that may be used to address other risk factors in unique cases include:


    Sleep Disorders Often Begin With Mouth Breathing

    Your kids should be breathing through their nose. Mouth breathing does not deliver adequate oxygen to their body. Young developing bodies and brains are oxygen hungry, which is why the impact on a childs health can be severe.

    Nasal breathing creates nitrous oxide in the nose which increases oxygen perfusion. It drives blood flow to the lungs by increasing blood flow, oxygen, and CO2 levels. It also slows the breathing rate and improves overall lung volumes.

    Nitric oxide is not produced if kids arent nose-breathing. Kids who mouth breathe, receive cold, unfiltered air that delivers little oxygen.

    One of the most obvious signs of mouth breathing is crooked teeth. Children with high palates have small nasal sinuses. Airflow through the nose is impaired, and mouth breathing can occur, especially during sleep.

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    What Are Risk Factors For Infant Sleep Apnea

    Small preterm infants are most likely to have infant sleep apnea. It sometimes occurs in larger preterm or full-term infants. It is less common in infants under the age of six months.

    During the first month after birth it occurs in 84 percent of infants who weigh less than 2.2 pounds. The risk decreases to 25 percent for infants who weigh less than 5.5 pounds. It is rare in full-term newborns.

    In preterm infants, infant sleep apnea tends to appear between the second and seventh day of life. It is rare on the first day of life. Its presence at birth is usually a sign of another illness.

    A variety of medical conditions can cause infant sleep apnea or make it worse. These problems include:

    • Acid reflux
    • Seizures
    • Small upper airway

    A small percentage of children who die from sudden infant death syndrome have apnea symptoms prior to death. But infant sleep apnea has not been established as a risk factor for SIDS.

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