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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Though relatively rare compared to snoring, sleep apnea does occur in children and it can have serious adverse effects and consequences. What are the symptoms of sleep apnea in children? How does sleep apnea affect intelligence, behavior, and growth? Discover the surprising impacts of untreated sleep apnea in children.

What Is Sleep Apnea in Children?

As in adults, sleep apnea involves brief partial or complete collapse of the upper airway leading to disrupted sleep. Each of these events may be associated with a drop in the oxygen level of the blood or an arousal from a deep sleep as the brain attempts to awaken the body to resume normal breathing. This may occur hundreds of times during the night and the result is non-restorative sleep.

In children, sleep apnea is defined 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 are considered to be abnormal. 

This may be associated with some surprising signs of sleep apnea in children, ranging from mouth breathing to bedwetting to sleepwalking. Even a child who restless and sweaty and sleep may do so because of struggling to breathe during 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, with an incidence which peaks between the ages of 2 and 6 because of enlargement of the tonsils and adenoids and a proportionately small airway. This crowding makes the airway more prone to obstruction and resulting apnea. The risk increases again in adolescence, but this may relate to obesity. Children with asthma or allergies are also more at risk of developing sleep apnea.

The Impacts of Snoring and Sleep Apnea on Intelligence, Behavior, and Growth

Until recently, snoring was believed to be a relatively benign condition in children. Unfortunately, recent research suggests that snoring, even without measurable apneas, is associated with cognitive, behavioral, and psychosocial problems. Children who snore do poorer on standardized tests of mental development. More specifically, they have been shown to have lower scores on learning and memory tests including some types of intelligence quotient (IQ) tests.

It is thought that sleep apnea increases sleep fragmentation, meaning that rather than prolonged periods within the sleep stages as would normally occur, there is a constant shifting as the affected child moves between deep and lighter sleep. Unlike in adults who become sleepy and sedate with sleep deprivation, children have the opposite response and become more hyperactive and unruly. As a result, this sleep fragmentation may cause difficulties with attention, hyperactivity, social problems, and anxiety and depressive symptoms.

Finally, sleep-disordered breathing in children is associated with a growth deficiency. Affected children may lose ground among their peers, and will even slow along their previous growth path, perhaps not reaching their full developmental potential. It is believed that frequent arousals from deep, slow-wave sleep may disrupt the hormonal secretion which occurs at this time, including the production of growth hormone. As a result, less hormone is available to promote normal growth.

The Evaluation and Treatment of Sleep Apnea in Children

Children who are suspected of having sleep apnea may be evaluated by a pediatric sleep specialist and may require an overnight sleep study at a sleep center. Home sleep apnea testing is not approved for use in children. 

Treatments for sleep apnea in children may include targeting the underlying causes, treating allergies, tonsillectomy, and orthodontic treatment called rapid maxillary expansion. In some children, the use of continuous positive airway pressure (CPAP) may be helpful. As the child becomes older, other treatment options may become available as growth continues to the adult stature.

Sleep apnea can have serious, long-lasting consequences in the growth of a child both mentally and physically. Therefore, it is important to recognize that snoring may not be as benign as it was once thought and may require careful evaluation by a pediatrician or sleep specialist.

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