Sleep Apnoea in children
Sleep apnoea means that your child stops breathing at night. It is a very common condition, and many parents find it very frightening.
What problems does sleep apnoea in children cause?
Usually the first thing that parents notice is snoring. Snoring itself in children is really common, so just because your child snores it doesn't mean they have sleep apnoea. You need to look for other signs too.
Things that you may notice include:
-struggling to breathe at night
-stopping breathing
-choking type noises
-excessive tossing and turning
-waking frequently
-bed wetting
-being tired in the morning and difficult to wake
-tiredness during the daytime
-hyperactivity during the daytime
-naughtiness
-poor attention spans
Taking a video recording of your child's sleeping to show your doctor will be really helpful.
What causes sleep apnoea?
There are actually two types of sleep apnoea. The commonest is obstructive sleep apnoea. This is caused by a blockage in your child's breathing passages. Overwhelmingly, the commonest reason for this is big tonsils and adenoids. Other causes include floppy larynx, or obstruction at the back of the tongue, or blockage due to a small jaw.
Increasingly, we are seeing overweight children where the cause of obstruction is obesity. If your child is overweight, losing the excess weight should be the first thing for you to do before you consider tonsil and adenoid surgery. Losing weight will also be good for your child in other ways, quite in addition to the snoring
The other, much rarer type of sleep apnoea is central sleep apnoea. This means that the brain forgets to breathe when it should. Usually, this is seen in children that also have other neurological problems.
How is sleep apnoea diagnosed?
Your doctor will want to know about the problems that you have noticed. Watching your child sleep will be useful, as will a video recording of their sleep.
The doctor may recommend a sleep study. This is a study of your child's sleeping. There are a variety of different ways of carrying this out, ranging from studies at home using an oxygen probe on your child's toe, to studies in hospital recording multiple aspects including chest movement and brain wave recordings.
There is no agreement amongst doctors on when sleep studies should be used. They can be useful in helping us make the diagnosis, but are not essential. If parents are just looking for reassurance that the snoring is nothing to worry about, then a sleep study can be helpful. In some parts of the country, surgery for sleep apnoea won't be funded by the NHS unless the child has had a sleep study, so that means that every child will have one before surgery can be offered. In other parts of the country the sleep studies themselves are restricted, which means that your doctor will have to apply for special permission to get it funded by the NHS. Usually there is a wait for sleep studies as well as for surgery, so if you are worried about your child and wish to get on with treatment as soon as possible, it's often best to come to the ENT clinic with a video and as much information for your doctor as possible, so that hopefully they will be able to make make a diagnosis and offer you surgery without a sleep study (if they are allowed to).
The rules about sleep studies may seem very confusing. Your doctor will know what needs to be done. The best thing for you to do is come with a good video, and as much information about your child's sleeping as possible.
Why does sleep apnoea need treating?
Sometimes sleep apnoea gets better quickly, so no treatment may be needed. But if it persists for a long period of time, it can affect a child's educational achievement, behaviour, growth and quality of life. It's probably OK to leave sleep apnoea it for a few months. However, if it persists, we would normally offer treatment, unless there are specific reasons not to.
How is sleep apnoea treated?
Because blockage by tonsils and adenoids is the main cause, the treatment is removal of tonsils and adenoids. This is called adenotonsillectomy. Have a look at the pages describing the adenoids and tonsillectomy surgery, and in particular look at tonsillectomy versus tonsillotomy, and what to expect after tonsil removal.
Surgery may involve an overnight stay, or some children may be suitable to go home on the same day.
Risks of surgery are:
-bleeding
-infection
-chipped or loose tooth
-lip bruising
-regurgitation of liquids through the nose when drinking
-voice changes
Vast majority of children are cured by adenotonsillectomy. Some children have breathing difficulties immediately after surgery, and some continue to have snoring problems in the long term. If your child continues to have snoring and breathing problems after surgery, make sure that you let your doctor know.
Remember that sleep apnoea is usually caused by tonsils and adenoids, but not always! If your child's sleep apnoea is caused by something else, your doctor will advise you on appropriate management strategy. This could include surgery, medication, observation, or machines to help the child sleep.
