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Alaska Sleep Education Center

Children with Sleep Apnea

Posted by Jennifer Hines on Dec 10, 2019 7:15:00 AM

Kids Can Get Sleep Apnea?

Any person, any age, can fall victim to obstructive sleep apnea—from new-born infants to those over 100 years of age.

Sleep Disordered Breathing

Sleep disordered breathing (SDB) is a general term that includes breathing difficulties during sleep. Obstructive sleep apnea (OSA) is included in this classification, but also included are less severe (but still significant) breathing patterns, such as upper airway resistance and flow limitation.

Sleep apnea is a respiratory disorder that presents itself as a partial or complete closing of the airway during sleep. Many factors that affect breathing and the airway structure contribute to the risk of having sleep apnea.

OSA Symptoms in Children

OSA displays differently in pediatric patients than it does in adult patients.

Obstructive sleep apnea is the partial or complete repeated closing of the airway during sleep. Children need oxygen, the same as adults do. During sleep, the brain and body construct, repair, restore and regenerate itself.

 If the brain and body are not getting oxygen in adequate amounts, a child’s growth and development can be thwarted by this lack of oxygen. This lack of oxygen causes stress hormones to be released into the bloodstream.

Not only does the body and brain not have enough oxygen to do its jobs, it now has added “fight-or-flight” hormones coursing through the body, creating a disease-promoting environment.

Children’s rapid growth and development cause them to be even more vulnerable and susceptible to cell damage caused by this lack of oxygen during repetitive apneas.

Each child is an individual, and their response to the affects of sleep apnea will be different from another child’s. One child may have behavior problems as a result of OSA while another may be a star student but wet his bed at night.

It is estimated that 30% of children who are diagnosed with ADHD really have obstructive sleep apnea. Children can be shamed for bedwetting, when in fact it may be the result of sleep disordered breathing and should be treated medically.

If your child shows any of the signs, symptoms or behaviors stated in the long list above, please have them evaluated for a sleep problem. You may be saving your child and yourself years of physical and/or mental discomfort by finding out the real reason. 

Factors That Affect Pediatric Sleep Apnea

According to Dr. Mary Cataletto, in non-obese and otherwise healthy children under the age of 8 years old, the prevalence of OSA is one to three percent. Most children show symptoms of sleep apnea between 2-10 years of age. Those with severe obstructive sleep apnea are likely to show signs and symptoms at 3-5 years of age.

Snoring is the sound produced when air passes through a restricted airway caused by its partial closure. As the air passes through the restricted airway, the throat tissues in the airway will vibrate, causing the snoring noise.

Habitual snoring affects about 10 percent of children aged 2-8 years of age. If snoring begins within the first few months of life, the child’s chances are increased for sleep apnea.

Snoring can be a sign of sleep apnea or it can be just an annoying noise the person makes while sleeping, which does not adversely affect their sleeping, but may disrupt the nearby sleepers' sleep!

More Risk Factors

According to Tanya Weinstock, obstructive sleep apnea is strongly associated with race. Black children younger than 18 years of age are 3.5 times more likely to develop OSA than white children.

There is a strong association of sleep apnea and environmental tobacco smoke, according to Dr. Weinstock. Children who live in parent-smoking households are more likely to have sleep apnea than children living in non-smoking households.

We have an obesity epidemic in our country. Pediatric obesity increases the risk of sleep disordered breathing 4 to 5 fold. OSA occurs in up to 60% of obese children.

Obesity is a significant problem for our culture, and pediatric obesity has many implications, including a propensity toward adult obesity, and increases in diabetes rates and cardiovascular problems (hypertension, heart disease and stroke).

Adenotonsillectomy 

Most children’s OSA is associated with large tonsils and adenoids. The first line of treatment in most children with OSA is adenotonsillectomy. This cures the OSA in about 75% of children. Some children, even after surgery, may still have airway obstruction due to large lymph nodes or other reasons.

Other children, such as obese patients and Down syndrome patients, may not be good candidates for surgery, requiring physicians to find other solutions for their OSA. For non-surgical candidates and those who have had surgeries that have not resolved the OSA, CPAP is the treatment of choice. 

CPAP Treatment

In children, CPAP is usually the second choice due to pediatric low compliance rate. Like some adults, children have difficulty having a mask on for 8 or more hours per night.

Carole Marcus, a pediatrics professor at Children’s Hospital of Philadelphia, states that treatment for children’s obstructive sleep apnea can improve the quality of life and behavioral issues. Even though it is difficult to get many children to be compliant and use the therapy for an entire night or on a consistent basis, Dr. Marcus found that pediatric patients using CPAP for only three hours a night showed a big difference.

The results of Marcus's study indicated that in spite of suboptimal adherence rates, there was significant improvement in neurobehavioral function in children after 3 months of CPAP therapy, even in developmentally delayed children.

Pediatric CPAP Masks

Years ago there were very few choices and designs for pediatric CPAP masks. Children would be given a petite or small adult mask and hope for the best. Of course, those masks did not fit a child properly and leaks developed which thwarted the quality of treatment, or discomfort caused the child to refuse to use it.

Mask manufacturers began making children’s masks a few years back to address the specific needs of children. 

With more and more children being diagnosed with sleep apnea as a result of the pediatric obesity epidemic, treatment for these children has become a major focus in the sleep medicine field. 

Mask manufacturers have developed different designs to give greater choice for patients.

Because children grow quickly, different pediatric masks fit different sized heads and faces. Until the last couple years, really small masks were not available. Currently masks available for infants to adolescents are on the market. Here is a list of the most current pediatric masks:

Respironics - Wisp Pediatric Nasal CPAP Mask - Philips Respironics (infants and up)

Respironics - Small Child Profile Lite CPAP Mask (1 year and older)

Circadiance - SleepWeaver Nasal CPAP Mask (2 – 7 years old)

ResMed - Pixi Pediatric CPAP Mask (2 years and older)

SleepNet - MiniMe 2 Nasal Pediatric Mask (2-12 years old)

ResMed - Mirage Kidsta Nasal CPAP Mask (7 years and older)

AG Industries - Nonny Pediatric Nasal CPAP Mask (fits children’s and small adults faces)

Respironics - Profile Lite Youth Size Gel Nasal CPAP Mask (fits children’s and small adult faces)

Pediatric masks accommodate a child’s needs, as well as appeal to a child’s nature. Respironics’ Wisp pediatric nasal mask has a giraffe print design on the frame to make things fun, and Circadiance’s SleepWeaver Advanced pediatric nasal mask incorporates a fabric cushion that seals gently to the face to protect delicate facial skin.

Summary

Children suffer from obstructive sleep apnea like adults do, maybe more so. Their rapidly growing and changing bodies and minds are susceptible to the lack of oxygen and needed nutrients that sleep apnea steals from them.

The first line of treatment is surgery, removing the tonsils and adenoids. If surgery is not successful in curing sleep apnea, or if other conditions are causing the disorder, CPAP is the treatment of choice.

In the last few years pediatric CPAP masks designed for children’s faces have become more readily available to treat the devastating disorder of obstructive sleep apnea.

Philips Respironics is another popular brand among CPAP users. They offer a variety of masks from nasal pillow masks to full-face masks.  This article will discuss the Wisp Nasal Mask and the DreamWear Nasal Cradle mask.

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Topics: CPAP Masks, children, CPAP, sleep and children, Pediatrics, cpap accessories, Family, sleeping

Back-to-School Sleep Tips for Parents, Children, and Teens

Posted by Jennifer Hines on Jul 31, 2019 11:50:00 AM

A new school year kicks off in 21 days!  Where did this hot Alaska summer go?  We all know what this means...our kids' lazy, relaxed days of summer are about to be replaced with packed schedules full of class time, homework, and after school activities. More than likely your children have been staying up late and sleeping in through much of their summer-break, and getting them back into a healthy sleep routine may be challenging to say the least.

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Topics: school, children, Sleep Tips, sleep and children, teens

Age and Sleep Apnea: Does Age Affect The Prevalence of Sleep Apnea?

Posted by Jennifer Hines on Jun 28, 2019 7:00:00 AM

Previously we discussed how not all patients with sleep apnea fit the typical profile of someone suffering from the sleep disorder. The notion that mostly middle aged, overweight men are the ones likely to develop sleep apnea is a misconception that often leads to misdiagnosis in atypical patients with sleep apnea.

And while it's true that heavyset men over the age of 40 are the highest "at risk" group for having sleep apnea, it by no means is a comprehensive representation of all sleep apnea sufferers.

For example, women with sleep apnea are often mistreated for other sleep disorders such as insomnia because many general practitioners hold tight to the belief that women aren't as likely to have sleep apnea as men.

Here we hope to shed light on how age plays a role in the development of sleep apnea, and symptoms, diagnosis, and treatments that my differ based on a patient's age.

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Topics: sleep apnea, sleep and children, sleep and elderly

Pediatric Sleep Studies: Prepare Yourself and Your Child

Posted by Jennifer Hines on May 19, 2019 1:50:00 PM

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What to Expect from Your Child's Sleep Study

We utilize the same tests used to diagnose and rule out sleep disorders in adults for children. However, because children are more likely to displace sensors during the night, we prefer to use attended studies rather than home monitoring.

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Topics: sleep assessment, sleep and children, Pediatrics

How Much Sleep Does My Child Need?

Posted by Jennifer Hines on Apr 11, 2019 11:09:45 AM

Parent's Guide to a Healthier Children's Sleep (Updated 2019) - Sleep Reports

Sleep apnea is rare in childhood as it usually affects adults. When it occurs in children, it can be very serious. Sleep apnea causes the affected person to stop breathing for short periods during the night. If your child has the condition, you may hear them snoring or breathing strangely, and it can disturb their sleep.

Sleep apnea in children requires prompt treatment because it can lead to learning and behavioural problems, issues with growth and heart problems. Children with the condition may need to have their tonsils or adenoids removed to clear their airway. They may also need a special mask attached to a machine to help regulate their breathing while they sleep. If the child is overweight, weight loss may help to improve or resolve their condition.

Even if your child does not have sleep apnea, parents face many obstacles getting their baby and themselves the sleep they require.  Hannah Stevens, blog writer for www.SleepReports.com shared an insightful and informative article with Alaska Sleep Clinic titled, "A Parent's Guide to Healthier Sleep in Their Children."  Here is an excerpt:

We’ve created a quick and handy guide to how much sleep your child needs at every stage of their development, along with some handy sleep tips for each age. Remember that very young children will not get all of their sleep at night- nap times contribute to their total sleep time. By the age of around 5, your child will probably no longer need a nap and should have adjusted to getting all their sleep during the night.

Newborn-2 months: 16-18 hours

Newborns usually sleep in chunks of around 2-4 hours each time. At this stage, they are simply not wired to sleep through the night like an older child or adult can. Some babies may sleep better if you swaddle them and/or use a white noise machine, as both of these methods can be very reassuring. Babies of this age should sleep flat on their back to avoid the risk of Sudden Infant Death Syndrome (SIDS) and do not need a pillow. For a better night sleep, every parents should use a good crib mattress to reduce the risk of SIDS.

2-4 months: 14-16 hours

At this age, you can begin to try and establish the start of a bedtime routine, for example by having a soothing bath and a story before bed. Your baby will still need naps totalling around 4-5 hours per day.

4-6 months: 14-15 hours

Many babies are able and ready to sleep through the night by this age, although some may not be quite there yet. To encourage longer sleep sessions during the night, you can try feeding your baby immediately before putting them to bed.

6-12 months: 14 hours

Your baby can now be put down to bed when they are sleepy but still awake. They may be anxious to be left at first, but with plenty of reassurance they will learn that you will come back in the morning when they wake up. It’s also important to check that your baby cannot escape from their crib, as some children of this age will be able to climb out and could potentially injure themselves.

1-2 years: 13-14 hours

A predictable nap and sleep routine is important for children of this age. Try and put them down to sleep at the same time every day and try to engage in familiar, soothing activities before bed. Your child will still need 2-3 hours of nap time a day at this age, with the balance of their total sleep time at night.

2-3 years: 12-14 hours

Some 2-3 year olds will be ready and able to transfer to a regular bed. Many parents also potty train their children at this age. Although some night-time accidents are inevitable and normal at this age, it’s a good idea to limit food and drink close to bedtime to keep this to a minimum. All the same, it’s a good idea to invest in some protective, waterproof bedding during this time. If your child uses screens, try not to allow them too close to bedtime.

3-5 years: 11-13 hours

By the time your child is 5, they probably won’t need a daytime nap at all any more. Don’t be surprised if your child experiences nightmares for the first time around now- bad dreams are very common at this age.

5-12 years: 10-11 hours

Although your child is older, they still need consistent routines, rules and boundaries around bedtime. Limiting screen time before bed is especially important, as children tend to access devices more at this age. Many older children have busy routines full of extra-curricular and social activities. However, it’s important that you do not allow this to encroach on their need for enough sleep.

 

Connect with Hannah's entire article here.

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Topics: sleep and children

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