Published March 13, 2007
Getting kids to sleep is never easy. Whether it's coaxing a cranky toddler into bed, or arguing with a tween to hang up the phone – bedtime is a frequent fight between parents and children. However, sometimes the problem is more than just youthful rebellion. If kids are tossing and turning all night - sleep apnea may be to blame.
The term "apnea" is derived from Greek and literally means "no breath." Sleep apnea is generally thought of as an adult disorder, but it affects children as well. According to Dr. David Gozal, Professor of Pediatrics at the University of Louisville and Director of the Pediatric Sleep Program at Kosair Children's Hospital, Louisville, Kentucky, the condition is one in which the upper airway becomes narrower during sleep and the child has difficulty breathing.
This constriction forces the child to wake up to catch his or her breath. Not only is there a problem with breathing, but there is also a reversal in the gases exchanged in the lungs. Oxygen levels are lower than they should be, while the carbon dioxide levels are higher.
Dr. Gozal explained that most common symptom of the condition is loud snoring 3 to 4 times a week. He added that although many people believe that snoring in children is normal, especially if the parents snore, this is a serious misconception.Snoring is not normal in children, and loud, persistent snoring is a condition that warrants a trip to the pediatrician.
The other symptoms parents should watch for include:
-- Restless sleep
-- Nightmares and night terrors
-- Difficulty waking up
-- Learning difficulty in school
There are a number of causes for the disease, but Dr. Lynn D'Andrea, Medical Director of the Pediatric Sleep Disorder Program at Children's Hospital and Health System in Milwaukee, Wisconsin, said it is most often caused by enlarged tonsils and adenoids.
She added that overweight children who have extra tissue around the neck could also suffer from sleep apnea because the tissue pushes on the airway. Other possible causes include:
-- Craniofacial anomalies such as an enlarged tongue, which is common in children with Down's Syndrome
-- Neuromuscular weakness
-- Smaller mandible (lower jaw)
-- Broken nose or a deviated septum
Both doctors agree that the condition is more prevalent in children than people suspect. Dr. D'Andrea says that 2 to 3 percent of all children between the ages of 3 to 6 suffer from sleep apnea. In these cases, the culprit is usually enlarged tonsils and adenoids. There seems to be a drop in the amount of cases after the age of 6, but the number spikes in the teen years with the issue of obesity.
Dr. Gozal puts the number of cases at 2 to 3 percent of all children between the ages of 0 to 10. He added that 10 to 12 percent of all children snore habitually in their sleep. Based on current criteria, 1 to 4 of these children has sleep apnea that needs treatment.
Diagnosing sleep apnea requires a sleep study or polysomnogram, which is administered by doctors who specialize in sleep medicine. According to the American Sleep Apnea Association, the recording devices used during a sleep study is similar in both adults and children. They typically include:
-- Electroencephalogram (EEG) to measure brain waves
-- Electroculogram (EOG) to measure eye and chin movement during the different stages of sleep
-- Electrocardiogram (EKG) to measure heart rate and rhythm
-- Chest bands to measure breathing movements
-- Additional monitors to sense oxygen and carbon dioxide levels in the blood as well as monitors to record leg movement.
None of the devices are painful, but the process may frighten young children. To ease the child's fears, many sleep labs permit parents to stay with the child overnight.
Once the child has been diagnosed, the result is often the surgical removal of the enlarged tonsils and adenoids. Both Dr. Gozal and Dr. D'Andrea caution that while surgery almost always improves the condition, it doesn't always cure it.
Dr. Gozal noted that in milder cases, some medications might be possible as a trial before surgery. He cited medications such as nasal steroids that are used in the treatment of asthma and rhinitis (inflammation of the nose), because they reduce inflammation making breathing easier.
Dr. D' Andrea mentions weight loss in obese children is an accepted form of treatment, but cautioned it is not a cure. No one knows exactly how much weight must be lost before the condition is rectified. She also added that some children require treatment with a C-PAP (continuous positive airway pressure). This machine blows air into the nose through a mask, which keeps the airway open and unobstructed.
While attention is focused on the child suffering from sleep apnea, it is important to remember that the disease also affects other family members. Dr. Julie Boergers, of Bradley Hasbro Children's Research Center and Brown Medical School in Providence, Rhode Island, led a study with 107 families of children ages 2 to 12 who were evaluated at a sleep disorders clinic. The children's sleep problems ranged from sleep apnea, night terrors and sleepwalking, to behavioral issues like refusing to go to bed.
The findings, published in the March 2007 issue of the Journal of Family Psychology, indicate that there is a link between children's and parents' sleep problems. Parents with children that had more than one sleep disorder reported an increased number of instances of daytime sleepiness.
The researchers also discovered that the link between parental and child sleep was especially significant for mothers. Mothers of children with sleep disorders had more instances of daytime sleepiness than fathers, even though both parents reported approximately the same number of hours of sleep per night.
The researchers concluded the reason for this discrepancy is because mothers take more responsibility for responding to their children's sleep problems, and this may result in their sleep being disrupted more frequently than the fathers' sleep.
Left untreated, sleep apnea will continue to deprive the weary of their rest. Its victims include the sleep-deprived child, forced to wake up many times a night to grasp for air; and the exhausted parents who get up to comfort their frightened child. Finding a solution to the problem can have a tremendous impact on quality of life for both. If you suspect that your child may have sleep apnea, make an appointment with his or her primary care physician as soon as possible to see if further evaluation is necessary.
FoxNews.com health writer Maria Esposito contributed to this report.
For more great information on living healthy through every decade of life, click here to check out Dr. Manny's book The Check List(Harper Collins, 2007).
Dr. Manny Alvarez is the managing editor of health news at FOXNews.com, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.