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Dr Shahzeidi My child snores - is that normal?
by Shahriar Shahzeidi,
M.D. FAAP, FCCP, FAASM

Right Photo: Dr. Shahzeidi moderating the Southern Sleep Society Conference and presenting his research and findings on muscular dystrophy.

Adults are not the only ones who snore. Researchers have found that 12% of normal children snore from time to time. Seven percent to 10% of children snore every night.

How do I know if my child snoring may be serious?

Although, snoring may not appear to be harmful, but snoring can cause medical and developmental consequences. It may indicate sleep apnea or it may indicate a milder condition called Upper airway resistance syndrome

What causes sleep apnea in kids?

In kids, the most common cause of obstructive sleep apnea is enlarged tonsils and adenoids, which may have become larger due to allergies or repeated respiratory infections. While sleeping there is a significant drop in muscle tone, which affects the airway and breathing. Many of these children have little difficulty breathing when awake; however, with decreased muscle tone during sleep, the airway becomes smaller, and the tonsils and adenoids block the airway, making the flow of air more difficult and the work of breathing harder. Think of it like breathing through a small, flimsy straw which occasionally collapses blocking airflow. Many of the short pauses, often lasting only a few seconds cause a brief arousal that increases muscle tone, opens the airway, and allows the child to resume breathing.

Sleep apnea is more common in children who are overweight; however, some children with enlarged tonsils and/or adenoids may even be underweight. Other children who are at high risk for sleep apnea include those with a small jaw, craniofacial syndromes, muscle weakness or Down syndrome.

Beyond yawns, some of the signs you can look for in your child while sleeping include:

• Sleeps in an unusual position, with head off or propped up with many pillows
• Stops breathing for very short periods during the night
• Sweats during sleep
• Sleeps restlessly
• Has headaches during the day, especially in the morning
• Falls asleep or daydreams in school or at home
• Bedwetting after the age of 5
• Snores loudly and often
• Snorts, gasps or completely wakes up after a pause in breathing
• Has behavior problems at school, day care or at home
• Is difficult to wake up even after a long night of sleep
• Is often cranky, irritable or grumpy
• Has attention-deficit/hyperactivity disorder (ADHD)

As mentioned in my earlier post, ADHD and Sleep in Children some of these signs are very much like those that are found in kids with ADHD. The most common signs of sleep apnea that are shared by ADHD are:

• Trouble concentrating
• Hyperactivity
• Nervousness

In fact, kids may be diagnosed with ADHD, when in reality it may be they are suffering with sleep apnea. These two problems can also occur together in the same child. Sleep apnea can also make ADHD symptoms appear more intense.

How do I find out if my child's snoring may be related to sleep apnea?

Talk to your child's physician if you are concerned about your child's breathing during the night, and request a referral for a consultation to a pediatric sleep specialist or schedule a consultation with a pediatric sleep specialist directly.

In addition, to a complete medical history and physical examination, An overnight sleep study (also called polysomnography or PSG) often reveals the full extent of the medical problem.

During a sleep study, a total of 16 sensors are placed on your child's head, face, chest and legs to record his or her sleep activities, from brain function and breathing patterns to eye activity and muscle tone. The sensors are gently placed on the skin with a sticky like substance and are completely pain free. The lines are long enough for your child to move around and turn over in bed. There is no risk or danger related to the sleep study, and often kids love to have their photo taken while 'wired'. Also, Mom, Dad or a caregiver are asked to stay overnight with the child during the study.

What treatment options are available for snoring or sleep apnea?

The treatment for obstructive sleep apnea is based on its cause. Unlike adults, the most common fix for sleep apnea in kids is to remove enlarged tonsils and adenoids that are causing the problem. Surgery will be evaluated and performed by an ear, nose and throat specialist.

In cases where sleep apnea is not caused by enlarged tonsils or adenoids, orthodontic measures may correct jaw positioning or other types of surgery are occasionally needed in children with craniofacial abnormalities. Weight loss and treatment of other medical problems may also be helpful in the management of obstructive sleep apnea. In cases where surgery or another treatment option is not helpful, another effective treatment is continuous positive airway pressure (CPAP). CPAP involves wearing a mask over the nose during sleep attached to a machine that blows air through the nasal passages and into the airway. This air pressure keeps the airway open and allows the child to breathe normally during sleep.

If left untreated, sleep apnea can cause poor growth ("failure to thrive"), high blood pressure, and heart problems. Sleep apnea can also affect behavior and cognition in kids. Thus, the earlier a sleep problem such as snoring or sleep apnea is identified and treated, the more quickly a normal sleep routine can be restored - for everyone, including Mom and Dad.

Sources
(1) American Academy of Pediatrics: Snoring Linked to Behavior Problems in Children Website (3/5/2012)
(2) National Sleep Foundation: Snoring in Children Website (December 2009)
(3) UCLA health, Sleep Disorders Center: My Child Snores Website (2014)
(4) American Sleep Apnea Association: Children's Sleep Apnea Website (2014)
(5) American Academy of Physiological Medicine and Dentistry: Child Growth and Development Website (2012)
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