When Hannah Peyton was 18 months old, she had surgery to repair her cleft palate. While the physicians fixed the defect, which affects the upper lip and roof of the mouth, they noted Hannah’s tonsils were large. A little more than a year went by, and Hannah’s mom, Amie, noticed the now 4-year-old wanted to sleep all of the time – upward of 14 hours straight. She also snored loudly – as loud as Amie’s husband. So the concerned North Texas mom recorded Hannah sleeping one night and saw that she seemed to stop breathing at times. She showed the video to her pediatrician, but when he brushed off the incident, Amie got a second opinion and was referred to the Sleep Disorders Center at Children’s Medical Center for a sleep study. During the study, Hannah stopped breathing 127 times between 9pm and 6am. The diagnosis: obstructive sleep apnea.
Obstructive sleep apnea is caused by an obstruction in the upper airway, which makes breathing difficult. The most common cause of obstructive sleep apnea in kids is enlarged tonsils or adenoids, says Dr. Kamal Naqvi, director of the Sleep Disorders Center at Children’s Medical Center in Dallas. The next most common cause, Naqvi says, is obesity, which he has seen an increase of in the last five to 10 years. In obese children, the fat deposits add pressure and narrow the airways.
So how can you tell if your child has sleep apnea? During an apnea, the child will appear silent (no air is getting in), followed by a loud noise (sucking in air). Some children also experience hypopnea, which is identified by shallow, loud breaths, when very little air gets in. Naqvi says to listen and watch for snoring, mouth breathing and gasping.
“Not enough oxygen is getting to the heart and lungs,” says Dr. Joseph B. Rosen, director of Sleep Medicine for Pediatric Pulmonary and Sleep Specialists at the Pediatric Sleep Institute. “The child’s brain will recognize this and wake the child up. However, this can happen hundreds of times over the course of the night, and that can be very disruptive to the child’s sleep. Other symptoms may include bedwetting and nighttime sweating, Rosen says. Parents can see signs during the day as well. Since a child with sleep apnea isn’t getting continuous sleep, they will likely be tired during the day.
Rosen notes that some of the daytime symptoms of obstructive sleep apnea – irritability, impulsivity, hyperactivity, difficulty focusing or being defiant – can affect a child’s performance in school and be confused with attention deficit disorder. Recent studies, in fact, have suggested that as many as 25 percent of ADHD diagnoses may be linked to symptoms of sleep-disordered breathing. “That said, ADD and OSA are separate medical conditions,” Rosen cautions. “A child can have ADD, obstructive sleep apnea or both.”
Rosen recommends that any child diagnosed with ADD or ADHD have a sleep evaluation, though not necessarily a sleep study.
In order to obtain a sleep apnea diagnosis, an overnight sleep study, or polysomnogram (PSG), is conducted one night in a sleep laboratory, Rosen says. The study will reveal how many times each hour a child has trouble breathing. Physicians also monitor brain waves and oxygen and carbon dioxide levels, Naqvi says. Treatment for obstructive sleep apnea usually involves surgery to remove the adenoids or tonsils. If obesity is the cause of sleep apnea, obviously weight loss is ideal. A continuous positive airway pressure (CPAP) machine is another possible treatment. The machine delivers mild air pressure via mask to keep the airways open.
If sleep apnea goes untreated, the brain is deprived of oxygen, carbon dioxide levels increase and blood pressure rises, Naqvi says. “Parents have concerns of surgery, and snoring can be regarded as cute,” he says. “But don’t take snoring lightly.”
Hannah, who hasn’t yet had her tonsils removed because the surgery would disrupt her cleft palate repair, sleeps with a CPAP machine these days. “At first, she did not want to wear it; the mask was really big,” says mom Amie. “They changed it to the pixie mask, and now she does it all by herself.” Whereas Hannah was once groggy and cranky upon rising, she now wakes up ready to go. “She has more energy during the day,” Amie says. “She’s more pleasant to be around.”
