Symptoms and Consequences of Sleep Apnea in Children

Developmental Problems Include Loss of IQ and Growth

The symptoms and consequences of untreated sleep apnea in children can be serious, affecting intelligence, behavior, and growth
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Sleep apnea can seriously affect a child's—and their parents'—quality of life. Read on to discover the causes, signs, possible consequences, and treatments for sleep apnea in children.

What Is Sleep Apnea in Children?

As with adults, sleep apnea happens in children when the muscles of the upper airway relax enough to temporarily reduce or obstruct airflow. This can occur repeatedly over the course of a night and result in disrupted sleep as the brain attempts to awaken the body and resume normal breathing. Each of these events may also be associated with a drop in blood oxygen levels.

In children, sleep apnea is said to be present when at least one apnea event occurs per hour of sleep as observed with a diagnostic sleep study. (For adults, more than five events per hour indicate apnea.)

Surprising signs of sleep apnea in children may include mouth breathing, bedwetting, sleepwalking, restlessness, and sweating during sleep. There are also several potential consequences for a child's mental and physical health associated with sleep apnea.

How Common Is Sleep Apnea in Children?

Approximately 1% to 3% of preschool-aged children have sleep apnea, compared to about 10% who snore. Apnea in children tends to peak between the ages of 2 and 6 because of enlargement of the tonsils and adenoids alongside a proportionately small airway. This crowding makes the airway more prone to obstruction and resulting apnea. The risk for developing apnea increases again in adolescence, but this may relate to obesity. Children with asthma or allergies are also more prone to developing sleep apnea.

Impacts of Sleep Apnea in Children

Sleep apnea may increase sleep fragmentation, meaning that rather than experiencing the normal periods associated with each sleep stage, a child with apnea moves more frequently between deep and lighter stages of sleep. Research suggests that the longterm effects of sleep apnea in children may include cognitive, behavioral, and psychosocial problems as well as growth delays and impacts on cardiovascular health.

Problems With Intellectual Development

Children with untreated sleep apnea may perform poorly on standardized tests of mental development. In a school-based study in India, children with sleep apnea were found to perform significantly less well in academic subjects than their peers. Other potential problems with intellectual development include lower scores on learning and memory metrics and on some types of intelligence quotient (IQ) tests. Children with the most severe apnea appear to also experience the most significant challenges to cognitive development.

Hyperactivity and Other Behavioral Problems

Unlike in adults—who become sleepy and sedate with sleep deprivation—children tend to become hyperactive. This may cause difficulties with attention and social behavior, and may also contribute to anxiety and depressive symptoms. Hyperactivity resulting from sleep apnea in children is sometimes misdiagnosed as Attention Deficit and Hyperactivity Disorder (ADHD).

An English study in the Journal of Thoracic Disease also showed that children with untreated apnea were more likely to exhibit poor social and communication skills and have difficulty regulating their behaviors. These traits are often experienced by caregivers as uncooperativeness or emotional volatility.

Inflammation

When sleep apnea continues over a long period in childhood, increasing markers of inflammation can also be found. Inflammation, in turn, can lead to a cascade of negative health outcomes such as compromised organ function.

Sleepiness During the Day

A child who is not getting enough restorative sleep at night could show signs of excessive sleepiness during the day. Babies and children need different amounts of sleep based on their age and stage, but if you notice your child napping longer or more frequently than usual or seeming tired when he or she is normally energetic, apnea could be the cause.

Issues with Growth

Sleep-disordered breathing in children is associated with negative effects on growth. Children with apnea may lose ground among their peers, or slow along their previous growth path, resulting in an inability to meet their full growth potential. This may be caused by frequent awakening from deep, slow-wave sleep which in turn could disrupt normal hormonal secretion, including growth hormones. In extreme circumstances, a child with apnea whose growth falls far below healthy levels may be diagnosed with failure to thrive.

Risk of Cardiovascular Problems

If left untreated, sleep apnea in children can result in certain cardiovascular problems like issues with blood pressure regulation, hypertension, and other precursors to cardiovascular events. During vigorous exercise, it's also possible that a child with untreated apnea will experience diminished cardiac performance.

The Evaluation and Treatment of Sleep Apnea in Children

Children whose caregivers believe that they may have sleep apnea can be evaluated by a pediatric sleep specialist. Because home sleep apnea testing is not approved for use in children, this could require an overnight sleep study at a sleep center.

Treatments for sleep apnea in children may include allergy treatment, tonsillectomy, and an orthodontic protocol called rapid maxillary expansion. In some children, the use of continuous positive airway pressure (CPAP) machines may be helpful. As children grow closer to adult stature, other treatment options become available.

Sleep apnea can have serious, long-lasting consequences on mental and physical development. It's important to talk to your child's pediatrician or a pediatric sleep specialist if you have reason to believe that your child may be experiencing sleep apnea.

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Article Sources

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Additional Reading

  • Shah SGS. A Commentary on "Ensuring safe surgical care across resource settings via surgical outcomes data & quality improvement initiatives" (Int J Surg 2019 Aug 5. https://doi.org/ 10.1016/j.ijsu.2019.07.036). Int J Surg. 2019;72:14-15.

  • Durmer, J et al. "Pediatric Sleep Medicine." American Academy of Neurology Continuum. 2007;153-200.