10 Surprising Signs of Sleep Apnea in Children

Watch out for Sleepwalking, Bedwetting, Snoring and Other Signs in Your Child

When referring to sleep apnea, you generally don't think of a child as someone who is typically affected by the disorder. However, sleep apnea is increasingly diagnosed in children who are either sleep deprived or experience tell-tale signs of the disorder during or after sleep. Knowing the signs can help seek an early diagnosis and appropriate treatment.

If left untreated, sleep apnea can have significant consequences on a child's growth, well-being, and behavior.

1

Snoring

Snoring may be a sign of sleep apnea in children

As a rule of thumb, children should never experience chronic snoring. An occasional snore is common with upper respiratory infections like the common cold but should not occur on an ongoing basis.

Chronic snoring is a sign of an abnormal flow of air through the upper airways that extends from the nose and mouth to the lungs. It is turbulence in these passages that produces the snoring sound.

Snoring often occurs hand-in-hand with sleep apnea, and, if your child snores, it is important to have it checked out. Other causes of snoring include allergies and enlarged tonsils or adenoids, both of which can be treated.

Chronic snoring in a child is a red flag that the child needs to be evaluated either by a sleep specialist or a pediatric otolaryngologist (an ear, nose, and throat specialist).

2

Mouth Breathing

Mouth breathing may be a sign of sleep apnea in children

Pierre Crom / Getty Images

 

Mouth breathing may be another sign of sleep apnea in children. Humans are obligate nasal breathers, meaning that we are meant to breathe through our noses. If the nose is chronically obstructed for whatever reason, mouth breathing can occur.

If left untreated, mouth breathing can spur the development of sleep apnea. By breathing through the mouth, the muscles of the jaw are in a relaxed position, leading an elongation of the face over time. It can also contribute to the weakness of the tongue and other muscles of the mouth and throat.

As a result, snoring and sleep apnea may more likely to occur in mouth-breathers than people who breathe normally.

3

Teeth Grinding

The Somnodent oral appliance is used to treat snoring and mild to moderate obstructive sleep apnea by advancing the lower jaw forward.
Brandon Peters, MD

Teeth grinding (also known as bruxism) can be disturbing, especially in children. But, it is also a little-known sign of sleep apnea.

Sleep apnea frequently occurs when the soft tissues at the back of the throat block the airway. Tightening the jaw and tongue can help prevent the collapse of the airway while in a supine (upward-facing) position but can also lead to teeth clenching and grinding.

Although mouthguards can prevent damage to the teeth, treating sleep apnea can usually resolve these and other symptoms of the disorder.

Molar damage and increased muscle tone in the jaw are two signs commonly seen in children and adults with sleep apnea.

4

Sweating

Excessive sweating in children during sleep may be a sign of sleep apnea

Cornelia Schauermann / Getty Images

Unless there is an overt fever, it is not normal for children to regularly wake up drenched in sweat. If pajamas, sheets, or blankets are soaked through in the morning, this may a sign that your child is struggling to breathe during sleep.

Sleep apnea is associated with decreased oxygen levels, spikes in blood pressure and heart rate, and increases in the stress hormone cortisol. When this occurs during sleep, excessive sweating is a common consequences.

5

Restless Sleep

Restless sleep is a sign of sleep apnea

Stephen Simpson / Getty Images

Children can sometimes be restless sleepers; extreme and persistent restlessness during sleep is another matter.

When breathing becomes difficult, as it does with sleep apnea, it can manifest with excessive movements during sleep. This is often the first sign of sleep apnea is younger children whose teeth have not yet fully developed.

Children with sleep apnea often sleep in unusual positions. They can often be found upside down in the bed, parallel to the headboard, or propped up in unusual ways in an attempt to splint the airway open.

If the covers are twisted into a ball at the base of the bed or found on the floor in the morning, this could be a sign of sleep apnea or other forms of respiratory impairment. Chronic restless sleep in children indicates the need for an evaluation by a sleep specialist.

6

Excessive Napping

Children tend to stop needing naps once they start school. If they don't, it may be a sign of sleep apnea.
Getty Images

At some point in their development, it is normal for children to stop taking naps. If they don’t, this could suggest that their sleep quality is poor.

Infants often take two to three daytime naps lasting 30 minutes to two hours. Between six and 12 months of age, a child will usually take two naps daily, lasting anywhere from 20 minutes to a few hours.

By school age, it is very unusual for a child to require daytime naps unless they are sleep deprived. Sleep apnea is one such cause that should be explored by a sleep specialist.

7

Bedwetting

Bedwetting may be a sign of sleep apnea in children

Zigy Kaluzny / Getty Images

Children often wet the bed at night, but it is considered to be a problem if it occurs twice a week after the age of five. Sleep enuresis, as it is called, affects between 3% and 30% of children between the ages of four and 12. It occurs during slow-wave sleep when a child is less able to be aroused if they have a full bladder.

Although sleep enuresis may be due to infection, stress, or other medical conditions, bedwetting can also be a sign of sleep apnea. Sleep apnea is believed to cause chemical imbalances in the brain that caninduce bedwetting not only in children but adults as well.

Studies showed that continuous positive airway pressure (CPAP) used to treat sleep apnea can all but eliminate bedwetting in adults with sleep apnea.

8

Sleepwalking

Sleepwalking in toddlers may occur due to sleep apnea

John Carleton / Getty Images

Sleepwalking may affect about 20% to 30% of children at least once between the ages of three and 10. It peaks around the age of five and becomes less frequent through adolescence.

Sleepwalking is associated with confusional arousal in which a child appears to awaken but remains in a confused, subconscious state. These episodes most often occur in the first third of the night.

Although the causes of sleepwalking are often unidentified, sleep apnea is believed to be a contributing factor. Brief stirrings are common when a child resumes breathing after a gap, triggering confusional arousal.

According to a 2018 review of studies in Frontiers of Psychology, children and adults with sleep apnea are far more likely to be sleepwalkers than those without.

9

Growth Problems

Growth problems may occur in children with sleep apnea
Getty Images

When your child visits the pediatrician, their weight and height may be monitored on a graph called a growth curve. This curve shows which growth percentile your child falls under compared to other children of their age and sex.

Children with sleep apnea will often "fall off the growth curve," meaning that they are abnormally small for their age. The interruption of slow-wave sleep is believed to be the cause of this.

It is during short-wave sleep that growth hormone (GH) is released, which aids in the development of bone and muscles, When short-wave sleep is chronically disrupted, a child can be deprived of GH, leading to growth impairment.

The treatment of sleep apnea has been shown to reverse the trend in some children and restore the growth trajectory.

10

ADHD

Sleep apnea may contribute to ADHD in children.

  Steve Liss / Getty Images

Attention deficit hyperactivity disorder (ADHD) is a fairly common diagnosis in children, and sleep apnea may be one of the more common contributing factors, according to a 2018 study from Germany.

Unlike adults who are sleep deprived, who usually experience daytime fatigue, children who are sleep deprived will often have the opposite effect, demonstrating hyperactive behaviors as well as forgetfulness, aggressiveness, distractability, and poor impulse control.

Sleep apnea is a condition often overlooked in children with ADHD, leading to misdiagnoses and inappropriate treatments.

A Word From Verywell

If you believe that your child may have signs of sleep apnea, start by speaking with your pediatrician. A referral to a sleep specialist can be arranged to explore your concerns and deliver the appropriate treatments if needed.

Be sure to keep a record of your child's symptoms, including dates and a description of events. If indicated, the sleep specialist can organize a non-invasive overnight sleep study (polysomnogram).

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