It’s hard to believe, but kids will be heading back to school in a few weeks. As parents, we will worry about many things that could influence our children’s academic performance — nutrition, the right balance of extracurricular activities, the influence of friends. However, one of the most common culprits of a nasty report card is snoring.
While many parents understand the value of sleep for their kids — we’ve all experienced a cranky child who’s had too little sleep or a missed nap — few realize the implications of snoring, which can be the result of obstructive sleep apnea and play havoc with your child’s classroom performance.
As obstructive sleep apnea (OSA) has gained more recognition for adults who suffer from snoring and sleep issues, many are still unaware that it’s a condition that can affect kids. Because OSA is commonly perceived as a problem exclusive to adults, caregivers and, sometimes, pediatricians can easily overlook it.
The presentation, incidence and management of OSA varies between adults and children. The most common sign of any patient with OSA is snoring. However, not every child or adult who snores has OSA.
The other nighttime symptom of OSA in both age groups is interrupted sleep patterns, gasping for air, and moving and tossing around in bed. Another symptom that may take place in children, but not in adults, is bed-wetting.
Additionally, daytime OSA symptoms in children may be different from adults, who may complain of excessive daytime sleepiness, tiredness and falling asleep easily during the day, at the job or even while driving. In children, OSA presents as agitation, hyperactivity and inability to concentrate. As a result, children with sleep disorder breathing or OSA often show symptoms of wild behavior, inability to sit still, difficulty focusing and poor concentration and attention span.
With symptoms like these, it’s obvious that OSA is not only a nighttime issue. It can adversely affect your child’s life, learning, speech and behavior. Studies have shown that kids with OSA have worse grades and school performance than children who do not. Therefore, if your child has suddenly changed behavior or received poor grades, it might warrant a trip to the pediatrician.
The diagnosis of OSA in children is commonly made by a pediatric ear, nose and throat (ENT) specialist based on clinical presentation. Your child might present with noisy breathing, loud persistent snoring, interrupted sleep, choking or gasping while sleeping, and tossing about while sleeping.
Upon examination, the doctor usually finds the patient has large tonsils and adenoids. The doctor might choose to evaluate the adenoids with a small endoscopic camera, but your child’s medical history and clinical presentation is usually sufficient to make the diagnosis.
Your doctor could also request a sleep study. If necessary, your child will visit a sleep center and have at least 12 different variables measuring their sleep and breathing, including oxygen saturation, airflow, number of times they stopped breathing (apnea), decreased breathing (hypopnea), blood pressure, electric activity of brain and other measurements.
Unlike adults, a sleep study is not routinely requested for children. It is only mandatory for children who have had a tonsillectomy and adenoidectomy yet continue to have symptoms of sleep apnea. It can also be prescribed for children younger than 2 or for patients who have a history of OSA, yet their physical exam does not match the symptoms.
Because OSA has similar symptoms as children with behavioral issues, ADHD or poor attention, it is critical to get a thorough medical examination, particularly because these other conditions are often treated with prescriptions that could be unnecessary if your child actually has OSA and not ADHD.
The good news is that OSA usually can be treated with a simple, outpatient surgery to remove the tonsils and adenoids. Children who undergo a tonsillectomy and adenoidectomy for their OSA have been shown to have improved school grades and behaviors a few months after surgery.
If you suspect your child is suffering from OSA or another sleep disorder, schedule an appointment with your pediatrician, or consult with an ENT specialist at the University of Miami Health System. To schedule an appointment with a pediatric ENT expert, call 305-243-3564.
Dr. Ramzi Younis is a pediatric ear, nose and throat expert at the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.
Symptoms of childhood sleep disorders
▪ Sleep walking
▪ Wild behavior
▪ Unexpected bed-wetting
▪ Frequent nightmares
▪ Poor growth