Snoring can be a normal symptom of a cold or virus in children. But when snoring persists and children have difficulty sleeping, parents should take their children to a doctor to look for signs of more serious conditions.
Snoring occurs in about 20 percent of children and is most common among children between 2 and 6, said Dr. Marcel Deray, a pediatric neurologist and director of the sleep disorders centre at Nicklaus Children's Hospital in Miami. About 10 percent of children who suffer from snoring have some sort of obstructive sleep apnoea, a sleep disorder that leads to pauses in breathing throughout the night.
"That's the peak time that kids have enlarged adenoids and tonsils, which is the main cause of snoring and sleep apnoea," Deray said.
Besides loud snoring, children may seem restless in their sleep, talk in their sleep, sleep in abnormal positions or sleep walk. Children may also begin wetting the bed again after not wetting the bed for months. All of these nighttime behaviours are signs that a child may need treatment for their snoring and that it could be sleep apnoea.
During the daytime, children suffering from sleep apnoea may wake up tired, irritable, moody and with headaches. Teachers may notice children falling asleep in class or having difficulty paying attention.
Environmental factors and allergens may also contribute to snoring. Children who are exposed to smoking can snore more. Obesity can also make children more prone to snoring because an obese person can have difficulty breathing. Children with Down syndrome or facial abnormalities are more likely to suffer from sleep apnoea because they have a greater chance of having a collapsed airway.
"Some risk factors [for snoring and sleep apnoea] may be kids that are overweight, so kids that have a body mass index (BMI) over 26. You want to be a little more proactive in screening for sleep apnoea," said Dr. Leonardo Torres, a pediatric sleep specialist at UHealth-the University of Miami Health System.
Diagnosis and treatment
If a doctor determines that snoring may be a problem for a child, the next step is to try implementing lifestyle changes and see if the child has a cold, viral infection or allergies.
Some lifestyle changes that Dr. Nivia Vasquez, a pediatrician at Baptist Health South Florida, recommends are eating a better diet, exercising, decreasing environmental irritants and avoiding smokers.
If those changes don't improve a child's sleep or related symptoms, a doctor will then recommend a polysomnogram, which is part of an overnight sleep study. The polysomnogram measures brain activity, eye movements, heart rate, blood pressure, oxygen levels, air movement and chest movements.
Nicklaus Children's Hospital has recently opened a second sleep disorders centre in Weston at the Dan Marino Outpatient Centre. Deray helped open the original sleep disorder center at Nicklaus in 1983.
"[The sleep study] entails spending one night in the lab," Deray said.
After identifying that a child has sleep apnoea, the next step is to identify the cause of the sleep condition. In almost all cases, sleep apnoea is caused by enlarged adenoids, soft tissue behind the nasal cavities, and enlarged tonsils. To try to fix the condition, doctors will remove the adenoids and tonsils in a surgical procedure called a tonsillectomy and adenoidectomy.
"There's no side effects other than the surgery and the anaesthesia. There's a very small risk of complication," Deray said.
After surgery, children will be monitored in a sleep study to ensure the cessation of snoring and sleep apnoea. If children still have difficulty breathing while sleeping after surgery, they can be put on continuous positive airway pressure (CPAP) therapy, where an electronic device delivers air to the airways throughout the night to prevent the throat from collapsing.
It's important to treat sleep disorders such as sleep apnoea in children because sleep deprivation and difficulty breathing over a long period of time can lead to permanent health problems. Permanent effects of ignoring sleep apnoea include being behind in school, not reaching optimal growth, developing lung problems and behavioral changes.
"If [sleep apnoea] is ignored and intervention isn't received, the child could end up having permanent adverse effects, such as health, behavioral or learning problems that could be prevented if they received the intervention," Vasquez said.
- Loud snoring
- Hearing gasps or snorting during child's sleep
- Sleeping in abnormal positions
- Wetting the bed after not wetting it for six months
- Headaches in the morning
- Falling asleep in class
- Mouth breathing
- Sleep walking/talking
Tribune News Agency