Watch out for your snoring children

Donya Betancourt, Pediatrician, drdonya@hotmail.com

Does your child snore? The fact of the matter is that 3 percent to 12 percent of preschool age children snore. And about 2 percent of the children that snore have obstructive sleep apnea syndrome (OSAS) which is increasingly being recognized as a leading cause for school and behavioral problems in children.

Why do children snore? Largely because the muscle tone in the tongue and throat are too relaxed, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep.

Children with large tonsils and adenoids often snore due to excessive bulkiness of throat tissue. Another possibility is obstructed nasal airways such as a stuffy or blocked nose, which requires extra effort to pull air through. So, snoring often occurs only during a cold or sinus infection.

Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction. Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny. Typically the person who snores causes others sleepless nights but medically speaking it disturbs sleeping patterns and causes sleep deprivation, long-term health problems, including obstructive sleep apnea.

What is Obstructive Sleep Apnea? When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea.

Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.

How do you know if your child is just a normal snorer or if he has obstructive sleep apnea? Children with OSAS usually have disrupted sleep with short pauses, snorts, or gasps in their sleep. Children with OSAS may also have behavioral problems, a short attention span and problems at school.

Other signs or symptoms might include: large tonsils and/or adenoids with frequent mouth breathing, hyponasal speech and nasal obstruction, poor weight gain, being overweight and high blood pressure. Testing can be done if it is suspected that your child has OSAS, including an overnight sleep study (nocturnal polysomnography).

Other testing may include audiotaping or videotaping your child's sleep, although you would likely need a specialist to interpret the tapes, use of overnight pulse oximetry to measure oxygen levels while he sleeps, or just performing a sleep study during a day time nap.

Once it is determined that your child has obstructive sleep apnea syndrome, it will be time to discuss treatment options, which usually include removing enlarged adenoids and tonsils (adenotonsillectomy). Other treatments might include treating a child's allergies and helping overweight children lose weight. Another treatment option is to have the patient sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or CPAP.

Doctors that specialize in treating children with OSAS include pediatric otolaryngologists (ear, nose and throat specialist or ENT), pulmonologists (a specialist in lung problems), or a neurologist who may be the first to recognize the problem because of the hyperactivity, inattentiveness, aggressive behavior, irritability, and mood swings associated with pediatric OSA.

Remember to be especially suspicious that your child may have OSA if he regularly snores and has apnea, daytime sleepiness, and/or school and behavioral problems. A chronically snoring child should be examined for problems with his or her tonsils and adenoids. A tonsillectomy and adenoidectomy may be required to return the child to full health.

The fact is; not everyone who snores has sleep apnea and not everyone who has untreated sleep apnea snores but snoring is a common symptom of sleep apnea.

Before undergoing surgery for snoring, it is wise to consider if sleep apnea is present. Untreated sleep apnea can be harmful to your health, and eliminating the snoring does not necessarily eliminate the apneas.