Sleep apnea in children and adults

Sometimes our normal sleep pattern may be altered and disrupted causing periods in which the individual fails to breathe or has apnea. It can affect children and adults. The causes could be due to a central pathology, where the brain no longer transmits signals to the body to actually breathe. There could be pathology in the respiratory tract (peripheral causes) that can obstruct the windpipe. These obstructions can be at one or multiple levels, from the level of the nose down to the voice box, or larynx.

Various neurological causes could be responsible for the central inputs during respiration causing apneic spells. These patients are managed by pediatricians, neurologists or pulmonologists. Obstructive apnea is most frequently treated by the otolaryngologist and in some cases a maxillofacial surgeon.

The most common cause of obstructive sleep apnea (OSA) in children is due to enlarged tonsils and adenoids (lymphatic tissue at the back of the nose). Nasal tumors, severely deviated septum, polyps can cause nasal airway obstruction. Retrognatism which pushes the tongue back, various craniofacial anomalies, excessively large tongue are important causes that can severely obstruct the airway causing sleep apnea. In children and adults, obesity has been shown to be a major risk factor for sleep apnea.

Sleep apnea can cause severe decrease of oxygen in the body which can be dangerous. The natural sleep rhythm gets broken and the patient awakens regularly during his sleep due to these apneic spells. As a consequence, one spends more time in light sleep and less time in the deep, restorative sleep that allows us to be energetic, mentally alert, and productive the next day. Chronic deprivation of sleep has effects on the the heart causing high blood pressure and stroke. The lack of sleep affects concentration, increased day-time somnolence, slow reflexes and increased risk of accidents. It leads to weight gain which has a cyclical phenomenon – meaning, increased weight gain increases the severity of the apneic spells which in turn increases the harmful effects of sleep apnea on the body.

Sleep disordered breathing includes snoring, restless sleeping and pauses in the respiration. Although sleep apnea is treatable, it often goes unrecognized. Learning how to identify the warning signs, how to distinguish it from normal snoring, is the first step in the management of sleep apnea. Children may adopt a certain position to overcome the obstruction. Parents may notice that their child is having difficulties in breathing during sleep. Partners may recognize change in sleep patterns, snoring and spells of complete cessation of breathing. Excessive weight gain needs to alert the presence of an abnormal sleep pattern.

An individual identified to have sleep apnea needs thorough evaluation by a sleep team comprising of various speciality doctors (ORL, maxillofacial surgeon, pediatrican, pulmologists and sleep pathologist).

The apneic spells need to be documented by performing a sleep study or polysomnography wherein the patient is hospitalized overnight. His sleep pattern is carefully studied, heart and brain tracings are recorded and oxygen saturation is documented. This study is done in collaboration with the sleep medicine specialists (Centre d'investigation et de recherche sur le sommeil) of the CHUV.

The patient needs to be seen for presence of obstructive pathologies in the upper airway which can be treated surgically. Children with Downs’s syndrome or Pierre Robin sequence and different craniofacial anomalies will have a higher incidence of sleep apnea and will require more extensive evaluations. Sleep fluoroscopy and an MRI can be used in special and more complicated cases of sleep apnea to determine the exact level in the airway where the obstruction is occurring. It's only when the presence of a sleep apnea and the exact cause are documented with the level of airway obstruction that treatment can be suggested.

Non surgical and surgical interventions are then adapted to fix the patient’s specific problem.