Sleep apnea is a very common problem in children. The causes of childhood sleep apnea can be threefold: central, obstructive or mixed.
The apneas of central cause have their origin in neurological problems, since they are produced when the brain does not send the respiratory stimulus. They are less frequent than obstructive apneas and usually occur when there is a neurological pathology, for example in very premature infants.
Obstructive apneas are the most frequent in children and are those in which some structure of the airway obstructs the passage of air, causing snoring and apnea pauses. The most frequent cause in children is an enlargement of the adenoids or palatine tonsils.
The growth of these structures may be ad hoc in response to infectious processes, resulting in snoring, nasal breathing, noisy breathing and obstruction at night, leading to OSAHS (Obstructive Sleep Apnea and Hypopnea Syndrome). It is rare that they are caused by a single cause, but nasal pathologies can also contribute to respiratory obstruction.
There is another very influential factor in obstructive apneas: obesity. This factor is a determining factor in these conditions, especially when added to large tonsils or adenoids.
Can it be prevented?
The only factor that can be prevented is obesity. The rest are specific to each child and there are no actions that parents can take to prevent their children from developing OSAHS. Even so, the complications of these conditions can be prevented through early diagnosis and treatment.
What treatments are currently available?
The treatment of childhood OSAHS has several parts. On the one hand, hygiene and sleep measures must be followed. It is essential to avoid childhood obesity, not only to avoid sleep apnea, but also for the child’s future.
Sleep hygiene is also fundamental: children must receive a sleep “education”, i.e. have more or less fixed schedules, sleep in a suitable environment (quiet and without lights), avoiding stimulating foods at night and avoiding exposure to screens before going to sleep.
On the other hand, there is medical treatment, which is used in mild cases, with adenoid hypertrophy, turbinate hypertrophy. In these cases, prolonged treatment with certain intranasal corticosteroids has been shown to improve symptoms.
In some cases, the obstruction may be caused by dental or postural malformations of the tongue. In these cases, orthodontic treatment should be initiated to correct the oral problems causing the obstruction.
In moderate cases of apneas, the treatment to follow is surgical. Surgery on the adenoids or tonsils is the most common treatment in these cases. The tonsils can be completely or partially removed.
Each of the surgical techniques has its advantages and disadvantages, so it must be assessed which is the most convenient in each situation. In this sense, it is common to perform sleep studies before surgery to assess the indication for anesthesia, since children with severe obstructions tend to have more post-surgical complications.
In exceptional cases, usually in children with mixed or central apneas, or those with severe obstructive apneas associated with malformations, a tracheotomy may be necessary to avoid serious complications.
What happens if they are not treated in time?
The consequences of not treating a child with apneas will depend on the severity of the apneas and whether the child has other associated diseases. Not treating significant obstructions can lead to different alterations.
On the one hand, alterations in dental, oral and facial development, which contribute to apneas problems in adults due to the same alteration in facial growth. The need for orthodontics, hard palate expanders is relatively frequent in older children who had an obstruction when they were small and were not treated.
On the other hand, alterations in cognitive development and learning. In young children with severe OSAHS, the quality of sleep is greatly affected, therefore learning and behavior may be altered.
Cardiac and pulmonary disturbances may also occur. In severe untreated cases or in children with underlying cardiopulmonary diseases, pulmonary hypertension or cardiac involvement may occur, but, I insist, these occur rarely, generally in children who are already ill and in severe cases that are not treated.