Snoring in Kids - An Insight

Your child's snore may sound cute, or even funny, but habitual snoring in children may contribute to many problems from bed-wetting to poor school performance. Many children snore, in fact, it is estimated that between 3% and 12% of preschool age children snore and about 2% of children of other ages also snore. Majority of the children are normally well, without any other symptoms but have primary snoring. Snoring is referred to as obstructive sleep apnea syndrome (OSAS).

What can cause snoring in children?

Snoring in children can be possible as a result from three things. Firstly, there can be an anatomical component, such as a small jaw or a small airway with which the child was born. Secondly, there is a possibility that the muscles and the nerves controlling these muscles may not be well integrated during sleep and therefore do not open the airway enough. But the most common and important reason for children snoring is enlarged tonsils and adenoids.

How common is snoring in the children?

It is very common condition in children to snore. How can you know if your child is just a normal snorer or if he has OSAS? Children who snore and do not have OSAS should be otherwise well, if they do not have other problems like daytime sleepiness and should have normal sleep patterns. In contrast to children with normal primary snoring, children with OSAS normally have interrupted sleep with short pauses, snorts, or gasps in their sleep. Children with sleep apnea can also have behavioral problems like short attention span and have problems at school.

Why should parents of habitual snorers be concerned about their children?

With habitual snoring, a child will have snoring at least three to four times a week, which is loud enough that the parents can definitely hear it. Parents should be aware of the fact that snoring can be associated with significant disruption of the quality of sleep and other underlying conditions which can affect the brain and the heart.

Difference between the upper airway resistance syndrome and sleep apnea:

Children with upper airway resistance syndrome may wake up sometimes because of the resistance in the airway or when their snoring is loud, or even when the snoring requires so much of effort. But there will be no changes in the oxygen or the carbon dioxide levels in the blood or in the tissues in the child.

In sleep apnea, the airway may collapse sometimes and doesn't open, and the child struggles for breathing and can't get any air in. As a result of it carbon dioxide goes up, the oxygen comes down, and naturally the child has to wake up in order to catch his or her breath. We can see children with many awakenings in the night just to catch their breath and get back to sleep.

Can chronic snoring be ever harmless in children?

We cannot say as Snoring is not normal but it doesn't mean that it always needs to be treated. Clearly, only when a child wakes up because of the snoring that is due to upper airway resistance syndrome or sleep apnea then they need to be treated.

What factors can increase risk for sleep apnea in children?

Obesity is the predominant factor. When you lay down and you have a large mass of fat in your neck, that can put even more pressure on the tissues that are already relaxed, and makes the airway even smaller causing difficulty in breathing.

Children who into a family that has a high risk of sleep apnea and children with Down syndrome, children who have their muscles relatively very weak - and children who have neuromuscular diseases are at much higher risk for sleep apnea than other children.

Obviously, when you have allergies, you get swelling in the lining of the nose, and that can lead to enlargement of adenoids. Some kids who are asthmatic have sleep apnea. However, in children whose parents smoke, have a major risk factor for snoring.

What are the short-term consequences of sleep apnea in children?

- You wake up in the morning after an un-refreshing sleep.

- You get tired and have difficulty in concentrating, and you feel groggy in the morning.

- Children may wet their bed because they're so anxious to sleep that they do not feel the pressure to urinate. This may lead to nightmares and night terrors.

- Children with sleep apnea have difficulty in concentration and kids who don't like to sleep resist their sleep by becoming hyperactive. They start fighting with everybody, and get irritated.

- Kids who are diagnosed with hyperactivity disorder can have sleep apnea, and if you try to treat the sleep disordered breathing their hyperactivity also disappears.

- If kids don't sleep well at night, the brain does not receive enough oxygen and may start losing brain cells. So brain development can be affected by sleep apnea.

- Children who are not doing well in school are more likely to have sleep apnea than other children. If these children are treated for their sleep apnea, their grades came up.

- If kids don't sleep well, they are hungry for calories the next day, especially fast calories such as fat and sugars. And if they are tired, they don't exercise and become more obese, and this makes the sleep apnea worse. So that leads to problems with cholesterol with pre-diabetic conditions and great risk for cardiovascular disease at an earlier age.

How can the sleep apnea be treated?

Tests can be done if it is suspected that your child has sleep apnea including an overnight sleep study called nocturnal polysomnography. Other testing may be audio-taping or videotaping your child's sleep. You can take the help of overnight pulse oximetry to measure oxygen levels while he sleeps. These other tests are useful if they do show sleep apnea, but a child can still have OSAS even if these tests are normal, so further testing may need to be done.

Once it is diagnosed that your child has obstructive sleep apnea syndrome, then it is the time to discuss treatment options, which include removing enlarged adenoids and tonsils. Other treatments include treating the child's allergies and seeing that overweight children lose weight. CPAP therapy with a nasal mask is another treatment option for children who do not need surgery or who continue to have sleep apnea even after their adenoids and tonsils removed.

Doctors who specialize in treating these children with sleep apnea include pediatric otolaryngologists, ENT specialist, pulmonologists or neurologists. If your Pediatrician diagnoses your child to be with sleep apnea, you would likely need to see one of these doctors

Some groups of children, including very young children with sleep apnea, or other disorders that may contribute to the sleep apnea, are retained in the hospital for at least 24 hours' monitoring after surgery, instead of treating the child as an outpatient.

Source: www.pediatrics.about.com/cs/conditions/a/snoring.htm

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