Do you children snore? Keep an eye on them

Primastuti Handayani, The Jakarta Post, Singapore

Most parents tend to ignore their snoring children. They are not aware that snoring is a sign of abnormality. Parents usually consider it to be a habit. "Our parents and grandparents also snore," is their most common reason.

But Christian Guilleminault -- professor of psychiatry and behavioral sciences at Stanford University and director of training at the Stanford University Sleep Disorders Center -- warned parents that snoring was a sign that children were having trouble breathing due to their upper airway being smaller than normal.

"The small tube in the airway means children are unable to breathe normally, which causes them to snore," he said in a two- day seminar on 'Ear, Nose and Throat Problems in Children, In Focus: Obstructive Sleep Disorders' staged by Mount Elizabeth Hospital in Singapore recently.

"The causes of noisy breathing during sleep can vary. It may be related to respiratory allergies, repetitive upper airway infections or the presence of small anatomic abnormalities of the upper airway during sleep," said the guest speaker.

Guilleminault, dubbed the 'Father of Sleep Apnea', said chronic snoring could be a trigger for nocturnal asthma attacks but it was mostly a key indicator of abnormal breathing during sleep.

"There are many symptoms that can be associated with chronic noisy breathing, starting from daytime irritability, aggressiveness, behavioral difficulties such as shyness, anxiety, repetitive terrifying nightmares, sleepwalking, bed-wetting, daytime lethargy, difficulties at school with learning impairment and morning headaches."

The abnormal breathing could lead to an obstructive sleep apnea syndrome in adulthood.

Guilleminault said most abnormal breathing sufferers were obese boys.

"Males usually store fat in their neck and stomach. The fat will surround the upper airway and therefore narrow the tube. People breathe like vacuum cleaners. The smaller tube will make children unable to breathe during contraction. It will make them use their mouths to breathe."

When parents find out that their infants snore, it is critical that they recognize the symptoms.

"If not all the causes of the problem are addressed early, it will affect the children when they grow up. Most importantly, we don't realize that snoring could lead to obstructive sleep apnea syndrome in adults. It is more crucial because during sleep the growth hormone is secreted. If they have sleep apnea then they won't grow normally."

Guilleminault said the problem could be exacerbated by the environment in which the children lived.

"In big cities like Jakarta and Bangkok where there is lots of pollution, children receive pollutants which give them swollen throats."

He also said that even sports activities during the daytime wouldn't help the children.

"My study shows that people have different brain mechanisms for the day time and night time. Therefore, when parents consult their pediatrician, which usually happens in the daytime, doctors will not see the symptoms. Parents themselves must pay attention to their children's behavior during sleep to enable them to describe the symptoms to doctors."

Mouth breathing will influence children's facial growth, with 60 percent of the adult face structure being determined by the age of four. Sufferers tend to have longer faces and sharper chins with a retracted jaw.

"The problem is more pronounced among East Asians compared to Caucasians because they tend to have longer faces anyway," he said.

Guilleminault said that children would search for the best position to sleep in due to their breathing disorder.

"If they lay down, the tongue will fall back and close their upper airway. If they sleep face down, they tend to bend their knees up to their stomachs. The best position is to sleep on their side."

"In certain countries, I see children sleeping on their mothers' backs during the daytime when the mothers are going about their activities. Actually, that's the ideal position to sleep in."

However, Guilleminault said the condition was completely curable and many treatments were available but an appropriate anatomic diagnosis was needed.

The surgical treatments range from tonsillectomy with or without adenoidectomy to lateral resection of the palatal walls.

"I myself had my son undergo a tonsillectomy at the age of 10 months. I call on parents and pediatricians to have the surgery as early as possible to avoid fatal consequences for children," Guilleminault said.

For snoring children, Guilleminault called on parents to seek orthodontic treatment related to the cause of the abnormal sound. He described his patients having braces on their teeth, which were meant to pull the jaw forward.

As for obstructive sleep disorder children, he recommended the use of nasal Continuous Positive Airway Pressure (CPAP) or Bilevel to help children overcome their breathing problem. CPAP is a mask with a long tube where the oxygen is brought to the child's nose under pressure.

Besides those measures, an appropriate interaction between pediatricians and orthodontists must occur early to avoid a latent problem before the end of puberty, which will give rise to an obstructive sleep apnea syndrome in adulthood.