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Ten percent of normal children in the U.S. reportedly snore nightly on a regular basis. Of these children, 2 out of every 10 may have a more serious condition called obstructive sleep apnea syndrome(OSAS). In OSAS, the upper airway is completely or partially blocked during sleep, resulting in noisy breathing (snoring), and sometimes reducing oxygen in the blood or causing poor ventilation (removal) of carbon dioxide (CO2). Children with OSAS may sleep restlessly, awaken frequently, sleep in unusual positions and be difficult to awaken in the morning. In addition, these children are often sleepy, inattentive in school, tired, cranky, and may experience developmental delays. In severe cases, the lowering of oxygen levels at night can cause damage to the heart and brain over the long run. Sorting out the "primary" snorers from the children with OSAS isn't always easy. A study by Dr. John Carroll at the Johns Hopkins Hospital last year showed that pediatricians and ENT surgeons, after hearing a detailed case history, could not pick out the kids that had OSAS from those that had primary snoring (the authors knew who had OSAS). This difficulty results because the symptoms don't often correlate with the disease; some kids whose parent's report mild symptoms have advanced OSAS and vice versa. Dr. Carroll's study concluded that when OSAS is suspected, the child should undergo a sleep study at a center specializing in children's sleep disorders to sort out the diagnosis. A sleep study records multiple measurements while the child sleeps. These include chest and abdominal movement (to show respiratory effort), airflow from the nose, oxygen and carbon dioxide levels, eye movements and brain waves used to stage sleep. Despite the large lists of parameters measured, the test is painless and all the measurements are made via "stick-on" probes. The child simply has to sleep in the laboratory for one night and the sleep doctor can then make a definitive diagnosis and recommend treatment options. The only caveat to testing your child for OSAS is that a pediatric sleep specialist, or a center with a specific pediatric program, should perform the study. Adult OSAS is an entirely different disorder than childhood OSAS. Both the physiology of the airway blockage in children and the number and type of obstructions seen are markedly different than in adults. Furthermore, if adult OSAS criteria (as published by the American Sleep Disorders Association) are used to "score" a child's study, the results will be incorrect. Treatment of childhood OSAS depends on the nature and source of the
airway blockage. Once your child has been diagnosed with OSAS, the sleep
specialists can help advice you as to which treatment option would be best
for your child. In most cases, children are "cured" after treatment
and most daytime and nighttime symptoms disappear. |
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