Do you children snore? Keep an eye on them

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.