The most common kind of sleep apnea is called Obstructive Sleep Apnea Syndrome. It is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation.
- excessive daytime sleepiness
- frequent episodes of obstructed breathing during sleep. (The patient may be unaware of this symptom — usually the parents are extremely aware of this).
Associated features may include:
- snoring – loud, squeaky, raspy
- nocturnal snorting, gasping, choking (may wake self up)
- restless sleep
- heavy irregular breathing
- excessive perspiring during sleep
- severe bedwetting
- bad dreams (nightmares)
- night terrors
- sleeps with mouth open, causing a dry mouth upon awakening
- chest retraction during sleep in young children (chest pulls in)
- sleeps in strange positions
- confusion upon awakening
- morning headaches
- unrefreshing sleep
- excessive daytime sleepiness
- may develop high blood pressure
- may be overweight or underweight
- learning problems
- excessive irritability
- change in personality
- difficulty concentrating
- Developmental problems
- failure to thrive or grow
- frequent upper respiratory infections
- hyperactive behavior
It is a potentially life-threatening condition that requires immediate medical attention. The risks of undiagnosed obstructive in children with sleep apnea include learning problems, developmental problems, behavior problems and in some cases, failure to grow, heart problems and high blood pressure. In addition, obstructive sleep apnea causes daytime sleepiness that can result in personality changes, lost productivity in school and interpersonal relationship problems. A child with sleep apnea may lag behind in many areas of development. The child may become frustrated and depressed. The severity of the symptoms may be mild, moderate or severe.
A sleep test, called polysomnography is usually done to diagnose sleep apnea. There are two kinds of polysomnograms. An overnight polysomnography test involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and audio monitoring. (for snoring, gasping, etc.) The second kind of polysomnography test is a home monitoring test. A Sleep Technologist hooks your child up to all the electrodes and instructs you on how to record your child’s sleep with a computerized polysomnograph that you take home and return in the morning. They are painless tests that are usually covered by insurance.
In children, simply removing the tonsils or adenoids may take care of the problem.
Sleep Apnea in children where removing the tonsils or adenoids does not take care of the problem is usually treated with a C-PAP (continous positive airway pressure) or Bi-Level positive airway pressure. C-PAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. Bi-Level has an inspiratory pressure that is higher than the expiratory pressure. The sleep doctor will “prescribe” the pressure and a home healthcare company will set it up and provide training in its use and maintenance.
When your child needs a machine, it can be quite intimidating. A C-PAP machine requires some care and a period of adjustment, but the benefits of C-PAP therapy are worth the inconvenience. C-PAP is NOT a venilator, it merely keeps the airway open so your child can breathe easily. It is not a complicated machine like some mentioned in the above link to kidshealth organization, nor do you have to worry about 24-hour nursing care or your child being in intensive care unless there are more complicated problems. A one night stay in a sleep clinic to monitor the child’s breathing is generally all that is required. Here are some tips if your child comes home on a machine. A C-PAP machine may be “prescribed” for your child. A home healthcare company that contracts with your insurance will provide the machine and show you how it works and how to clean and maintain it.
Find out about the different manufacturers who provide respiratory equipment for obstructive sleep apnea.
Some children have facial deformities that may cause the sleep apnea. It simply may be that their jaw is smaller than it should be or they could have a smaller opening at the back of the throat. Some children have enlarged tonsils, a large tongue or some other tissues partially blocking the airway. Fixing a deviated septum may help to open the nasal passages. Removing the tonsils and adenoids or polyps may help also. Children are much more likely to have their tonsils and adenoids removed to solve the problem.
The only available treatment for severe apnea until the early 1980’s was a tracheostomy. A tracheostomy is a surgical procedure where a small hole is cut in the neck and a tube with a valve is inserted into the hole. During the day the valve is closed so the person can speak. At night, the valve is opened, thus avoiding the obstructions. This procedure is only used today as a last resort or to avoid respiratory distress, or other serious medical complications (Your child would have to be extremely sick to require this).
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