Treatment of Snoring and Sleep Apnea in Children

Nightmares, bedwetting, and psycho-emotional disturbances are just some of the problems that can affect a child with obstructive sleep apnea syndrome (OSAS). This condition is characterized by repeated pauses in breathing during sleep, resulting in low blood oxygen levels, which can cause significant damage to the body.

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General information about sleep apnea and snoring

Obstructive sleep apnea is a common condition among adolescents, occurring in approximately one in every 100 children. It affects between 4% and 13% of children. The reason for these wide statistical variations is simple: detecting the disease is difficult, as its mild form is often unnoticed, and strict diagnostic standards do not exist.

OSA seriously impairs a child's well-being, hinders their physical and intellectual development, and increases the risk of serious illnesses. Therefore, developing new methods for early detection and effective treatment is a crucial task for pediatricians.

Snoring is a sound caused by vibrations in the pharyngeal tissues during sleep. Determining the prevalence of this condition in children is difficult because parents often do not consider snoring in their children to be a pathology and do not always seek medical attention. The incidence of apnea in the pediatric population ranges from 1% to 5% in the 2-6 age group.

General information about sleep apnea and snoring
Causes of sleep apnea and snoring in children

Causes of sleep apnea and snoring in children

Apnea and snoring in children occur for many reasons, for example, due to:

  • enlarged adenoids - the most common problem, when lymphoid tissue grows and blocks the airway
  • oversized tonsils - sometimes they begin to interfere with free breathing
  • growths in the pharynx - for example, the laryngeal tubes can also be thickened and narrow the space for inhalation and exhalation
  • elongated uvula - it can sometimes become greatly enlarged and create an obstruction to airflow
  • excess weight - excess fat presses on the throat from the inside, making the lumen smaller and causing snoring
  • cranial features - malformed facial bones lead to narrowing of the airways
  • brain diseases - some pathologies, such as childhood cerebral Paralysis or Down syndrome impair respiratory muscle control. Genetics - a number of rare conditions, such as mucopolysaccharidosis, alter the structure of tissues and organs, making breathing difficult. Nerve problems - disruptions in respiratory control can also lead to respiratory arrest.

At the first suspicion of sleep apnea in a child, for example, if they snore, it is necessary to take the child to a doctor.

Symptoms of sleep apnea

Symptoms of sleep apnea

OSA is characterized by two types of manifestations: symptoms that occur at night and daytime manifestations. Parents may notice the following nocturnal signs of sleep apnea:

  • Snoring – a loud and constant sound accompanied by difficulty breathing
  • Breathing problems – a feeling that the child is having difficulty breathing while sleeping, with frequent sighs and holding their breath. The child may seem to stop breathing altogether, sometimes even completely stopping breathing for several seconds.
  • Constant mouth breathing - many children are forced to keep their mouth open most of the night because their nose is blocked or not allowing enough air to pass through.
  • Excessive sweating - waking up in the morning to find wet clothes and bedding, even though the room is cool.
  • Urinary incontinence - urination at night, especially if it occurs repeatedly, although age suggests this is not a problem.

Daytime symptoms appear later and are associated with disruption of normal rest during sleep. These include:

  • Distractibility and absentmindedness – the child has difficulty concentrating on schoolwork, games, or daily activities.
  • Memory impairment and academic decline – poor concentration negatively impacts academic performance and overall learning.
  • Behavioral changes – children with apnea tend to become overactive, irritable, short-tempered, and aggressive.
  • Drowsiness and low activity – children and adolescents experience a strong need to rest during the day, feeling tired and weak.
Pathogenesis of OSA

During deep sleep, a child's pharyngeal muscles gradually relax, becoming softer and more flexible. This effect is especially pronounced in the presence of congenital defects or inflammatory processes, causing sagging of the soft tissues and temporary closure of the airway. A lack of oxygen supply causes acute oxygen starvation, forcing the brain to urgently mobilize the body's energy.

With obstructive sleep apnea syndrome in children, a stress response is triggered, activating the nervous system. The brain receives alarm signals and partially awakens from deep sleep, restoring tone to the pharyngeal muscles and restoring airway patency. The child reflexively takes deep breaths, replenishing the oxygen deficit. Typically, such episodes occur automatically, without leading to full awakening.

General information about the procedure

Diagnosing Sleep Apnea in Children

If your child has started snoring periodically and becoming restless in their sleep, it's time to visit an ENT specialist, pediatrician, or neurologist.

To make a diagnosis, the doctor conducts a detailed examination and interviews the child and parents, after which they are referred for a specialized sleep study – polysomnography (cardiorespiratory monitoring, computerized sleepography – using the Watch PAT device). During sleep, this study allows for an assessment of the frequency and severity of episodes of breath holding. The specialist then determines treatment.

Once the diagnosis of apnea is confirmed, sleep endoscopy may be performed if indicated.

Sleep endoscopy helps the doctor determine and pinpoint the level at which obstruction occurs and the child stops breathing.

Based on the examination results, the child will be recommended effective treatment for snoring and apnea. K+31 Clinic has the necessary equipment and qualified doctors to diagnose and treat this condition.

  • Polysomnographic testing ("sleep on a computer") is the gold standard for diagnostics. The patient sleeps under computer monitoring, which records heart rhythm, respiratory rate, oxygen saturation, and electrical activity of the brain and heart. The test allows for an accurate count of the number of suffocation episodes, their duration, and severity.
  • Cardiorespiratory monitoring. A simpler method of sleep monitoring, which records only key indicators of respiration, pulse, ECG, and blood oxygen levels. Suitable for moderate to severe forms of breathing problems, but less effective in mild cases.

For severe signs of attention deficit hyperactivity disorder, memory and behavioral problems, regular bedwetting, and other mental health issues, a consultation with a psychologist, psychotherapist, or psychiatrist is necessary. These specialists assess the child's mental and emotional health and conduct tests to identify possible developmental and learning disabilities.

Diagnosis of sleep apnea in children

Treatment for Obstructive Sleep Apnea and Snoring

Possible treatment options for snoring and apnea in children:

  • Surgical treatment by an otolaryngologist. If the snoring problem is related to the adenoids and tonsils (regardless of the size of the tonsils), surgical treatment (endoscopic adenotomy and/or tonsillotomy/tonsillectomy) will be recommended.

    Also, depending on indications, the following may be performed:

    • Pharyngoplasty
    • Uvulopalatopharyngoplasty
    • For tubal ridge hypertrophy — tuboplasty
    • For lingual tonsil hypertrophy — lingual tonsil reduction
  • Treatment by an orthodontist and maxillofacial surgeon. Use of intraoral devices, orthognathic treatment.
  • Myofascial therapy (myogymnastics). Myogymnastics of the oropharynx includes exercises for the oropharyngeal muscles, posture training, and breathing. This treatment method can be used as pre-treatment in patients with mild OSA and as a concomitant treatment after surgery.
  • CPAP therapy. When other apnea treatments are contraindicated or ineffective, a sleep physician will prescribe CPAP therapy, while simultaneously treating any underlying conditions (e.g., weight loss in obesity).
Treatment of obstructive sleep apnea and snoring

Complications

Obstructive sleep apnea in children causes serious physiological changes affecting various organs and systems. These disorders can lead to severe complications if the condition is long-term. The most noticeable signs are prolonged oxygen deprivation, manifested by sudden mood swings, increased excitability, and an inability to concentrate and learn. Severe apnea often leads to delayed psychoemotional and physical development in children. Severe apnea can cause hypoxia (lack of oxygen), arrhythmias, and high blood pressure, which increases the risk of sudden cardiac death. However, timely diagnosis and treatment of OSA effectively reduce these risks.

Another dangerous consequence of apnea in children is the development of metabolic syndrome and type 2 diabetes. This is associated with changes in the circadian rhythm of production of important hormones and increased cellular resistance to insulin. Simultaneously, the production of somatotropin, a growth hormone whose peak occurs during deep sleep, is disrupted. A deficiency of this hormone is reflected in stunted growth, muscle weakness and deficiency, and excess weight gain.

A lack of oxygen causes the child's body to overproduce substances similar to adrenaline, leading to overstimulation of the nerve centers that regulate the heart and blood vessels. This effect remains unnoticed for a long time, but subsequently serves as the basis for early vascular diseases, high blood pressure, arrhythmias, and heart attacks.

Complications

Prevention

Regular sleep in children is the foundation of a healthy nervous system and proper development. During deep sleep, the body recovers, important growth hormones are produced, and the immune system is strengthened. Sleep disturbances interfere with normal brain development and negatively impact a child's behavior.

If your child constantly wakes up tired, irritable, cranky, or complains of a headache in the morning, this is cause for concern. You should carefully observe them before they fall asleep and notice any warning signs early.

How to prevent sleep problems, snoring, and apnea:

  • Establish a clear daily routine – put your child to bed every night at approximately the same time.
  • Create a comfortable resting environment – ​​ventilate the room, maintain an optimal temperature of around 18-20 degrees Celsius.
  • Avoid watching TV and using gadgets at least two hours before bedtime.
  • Limit sweets in the evening.

It is also important to regularly visit your pediatrician and inform them of any changes in your child's behavior and sleep patterns. The doctor will be able to assess the condition of the throat, nose, and mouth of the little patient and rule out upper respiratory tract infections. Sometimes, a simple procedure such as adenoid or tonsil removal is enough to permanently eliminate problems with sleep.

Don't forget about hardening and physical activity. Physical exercise strengthens the chest muscles and improves circulation, reducing the risk of snoring and respiratory arrest. It's important to gradually increase activity, starting with simple activities like swimming or walking outdoors.

It's worth gradually hardening your child: you can start with air baths at home, then move on to water activities, including contrast showers and swimming. To prevent sleep disturbances in your child, remember the importance of regularly monitoring your child's health, maintaining a daily routine, and maintaining a healthy lifestyle for the whole family. Be attentive to changes in your child's well-being and respond promptly to any suspicious symptoms.

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Spiranskaya Olga Aleksandrovna
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Olga Aleksandrovna
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Leading otolaryngologist, ENT surgeon, pediatric ENT
Chekaldina Elena Vladimirovna
Experience 14 years
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