PEDIATRIC ENT
Sleep Apnea

Sleep apnea is a disorder that occurs when your child’s breathing is disrupted during sleep.

Your child may snore heavily, stop breathing for 10 seconds or more, several times a night, feel tired (or be hyperactive!) during the day, sweat heavily at night and/or wet the beds although having been potty trained. In children, enlargement of inflammation of the tonsils and adenoids is the most common reason for sleep apnea. When sleep apnea occurs in children, this lead to a reduced uptake of oxygen at during sleep.

This may lead to several long term problems such as heart and lung disease, but also growth delays and cognitive delays. Sleep apnea may reduce a child’s IQ by 10 points, and can be associated with behavioral problems including ADHD, hyperactivity, anxiety, depression and aggression, as well as learning and socializing problems.

During your child’s consultation for sleep apnea, examination may include one or more of the following:

 

Intraoral inspection-this is an examination to assess your child’s tonsils more in detail. We assess the mouth with a headlight that enables us to see the structures in your child’s mouth and the tonsils in particular. We look at the size, and more importantly the aspect of your tonsils. 

Flexible endoscopy-this involves inserting a small camera into your child’s nasal cavity to inspect their adenoids. The adenoid is a small patch of tissue sitting at the back of the nose. When the adenoid is enlarged or inflamed, it can cause or contribute to sleep apnea in children. Flexible endoscopy is done awake, but a local anesthetic (numbing) spray can be used. In children, a smaller size endoscope is used. Flexible endoscopy is not always necessary, especially when there is a strong history of sleep apnea, and surgery has already been decided on. We may in those cases choose to assess your child’s adenoid while under anesthesia.

Nose Diagram
  1. nasal cavity
  2. throat
  3. oral cavity
  4. tongue
  5. flexible tube
  6. endoscope
    Illustration used with permission from MedicalVisuals.

Palpation of (feeling) the neck- feeling the neck to assess for swollen lymph nodes that are often associated with recurrent tonsillitis. 

Sleep study- your child may be referred to one of our clinics for a sleep study. This is an overnight test that measures your child’s oxygen levels during sleep, amongst others. This study can help us detect the presence and severity of your child’s sleep apnea. In selected cases, a sleep study may also be carried out at home with a portable monitor kit. A sleep study is generally not necessary as a diagnostic tool for sleep apnea, but rather as a tool to assess the severity of sleep apnea and the consequent need for special measures that need to be taken after surgery. This is most relevant in children with a more complicated medical background, and in very young children. In children 3 years of age and older, with a straightforward history of sleep apnea and no relevant medical history, a sleep study is not usually necessary. 

The following treatments may be offered:

Watchful waiting- sometimes it is difficult to tell whether your child’s disturbed sleep is consistent with true sleep apnea. They may also have suffered from disturbed sleep for quite some time, but have improved spontaneously just before your consultation with us. We will usually ask you to observe your child’s sleep a few nights per week, and if possible, take audio or video footage of your child’s breathing pattern to future consultations for us to watch together. Observation during sleep is best done in the early hours of the morning. While we wait and monitor your child periodically, episodes of disturbed sleep may become less severe and symptom free intervals may lengthen or episodes may stop happening altogether. We may in some cases prescribe a nasal spray to help unblock your child’s nose and see if this helps them breathe better. Watchful waiting is a strategy we establish together, depending on your child’s situation and your wishes. We will continue to monitor your child at certain time intervals and our mutual decision may change at any time. 

Adenotonsillectomy-this is a surgical procedure during which we remove your child’s tonsils and adenoids. Adenotonsillectomy always happens under general anesthesia in a hospital setting. When adenotonsillectomy is carried out for sleep apnea, your child will need to stay one night in hospital, to monitor their breathing after the procedure. Your child’s oxygen levels will be monitored during the night with a monitor attached to their finger or toe with a plaster. When oxygen levels have been normal throughout the first night after adenotonsillectomy and your child is fit and well, they are discharged home the day after the procedure. More information can be found in our patient information folder.