Disruptions in sleep have plagued many in recent years, leading to complications like daytime drowsiness, lack of concentration and weakened immunity. However, such issues call for heightened concern if they appear in children. If your little one looks tired and drowsy in the daytime because of disturbed sleep at night, it could be an indicator of pediatric obstructive sleep apnea (OSA), a condition that is often overlooked or misdiagnosed. Early detection and effective treatment strategies can help children breathe easy, thereby avoiding long-term health complications.
Prevalence of OSA in children
According to the American Thoracic Society, OSA is defined as a sleep-related breathing disorder characterised by prolonged complete or partial obstruction of the upper airways that disrupts normal breathing and regular sleep patterns. Around one to 10 per cent of children are diagnosed with this condition, and it is mostly seen among kids in the age group of two to six years; however, it may also be diagnosed in older children.
How is OSA caused?
The nose, nasopharynx [passageway behind the nose that contains the adenoid glands and connects the nasal cavity to the upper part of the throat] and larynx [voice box] constitute the upper airways. In case of OSA, the upper airways get obstructed due to various reasons, the most common being enlargement of the adenoids and tonsils.
“Because of this, the respiratory tract becomes narrow, and the child does not get enough oxygen. The problem gets worse during sleep, causing breathing difficulty and night-time awakening,” said Dr Suresh Natarajan, consultant pediatrician and pediatric pulmonologist at Rainbow Children’s Hospital, Chennai.
Often, it may be triggered by allergens or infections (viral or bacterial) in the respiratory tract. OSA may sometimes be accompanied by a cold, cough or wheezing, he added.
Risk factors of OSA in children
“Children who are prone to allergies, infections or suffer from chronic respiratory problems such as allergic rhinitis, sinusitis and so on are at risk of developing OSA. Obesity is also a major risk factor, as fat deposits tend to block the airways, especially when the child is sleeping,” says Dr Natarajan.
According to him, other risk factors for developing OSA include:
- Down’s syndrome.
- Metabolic disorders (such as mucopolysaccharidoses) that are present at birth.
- Congenital defects that cause malformations in the face and respiratory system.
- Cerebral palsy.
- Neuromuscular conditions.
- Injury to the brain during the time of birth.
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When four-year-old Apoorva Shah (name changed) was brought to a hospital in Bengaluru with a severe respiratory infection, he had difficulty breathing and would not close his mouth. On examination, it was found that his upper airways were obstructed.
“The parents brought their child to me for regular immunisations until he was 18 months old. When I started taking the medical history, the parents said he was snoring, having disturbed sleep and getting up and shouting at night. He also had recurrent respiratory infections,” said Dr Santosh Kumar, consultant pediatrician and neonatologist, Motherhood Hospital, Banashankari, Bengaluru, who treated Apoorva.
He was diagnosed with OSA after investigations revealed enlarged adenoids obstructing the airways. “Treatment with nasal spray decreased the size of the adenoids, and in one and a half months, the child’s condition improved considerably,” he added.
Pediatric OSA is often overlooked or mostly diagnosed only when the child is brought to the clinic for treatment of respiratory infections, say experts.
What happens if OSA is left untreated?
Initially, the child may be drowsy in the daytime and even fall asleep in class. Slightly older children (7–8 years old) may complain of morning headaches due to lack of proper sleep. They will start performing badly in academics, and many have attention-deficit/hyperactivity disorder (ADHD).
“In the long-term, OSA can impact the physical growth of a child, affect developmental and social milestones as well as lead to impaired cognitive function and behavioural disorders. Severe OSA can even cause heart problems, hypertension and impaired lung function,” he adds.
Lifestyle measures for preventing OSA
According to experts, measures that can be taken for managing and preventing OSA include:
- If OSA is caused by an allergic reaction, the allergen must be identified and removed.
- OSA in overweight or obese children can be managed through an effective weight loss regimen.
- Parents must encourage children to follow a healthy diet, drink enough fluids and follow an active lifestyle.
- For some children, sleeping in the side position or with their head elevated may help.
- Breathing exercises can help by strengthening the muscles in the face, mouth and throat.
Treatment for OSA
According to Dr Natarajan, treatment options for OSA include:
- Medications in the form of inhalers, topical creams and nasal sprays to reduce the size of the adenoids for mild to moderate OSA.
- Continuous positive airway pressure (CPAP), wherein continuous air pressure is delivered via a machine (that uses a tube connected to a mask which fits over the nose and mouth) to keep the upper airways open during sleep.
- Adenotonsillectomy, a surgical procedure performed under general anesthesia to remove adenoid and tonsil tissue. It is recommended in severe cases.
Takeaways
- OSA is a sleep-related breathing disorder characterised by prolonged complete or partial obstruction of the upper airways, disrupting normal breathing and regular sleep patterns.
- Children who have allergies, infections or suffer from chronic respiratory problems such as allergic rhinitis, sinusitis and so on are at risk of developing OSA.
- Identifying and removing allergens, having a healthy diet and following an active lifestyle can help manage the condition.
