Sleep Apnea in Children

Doctors Should Screen Kids for Snoring and Sleep Apnea
Mon Apr 1,11:48 AM ET

By Melissa Schorr

NEW YORK (Reuters Health) – For the first time, the American Academy of Pediatrics (AAP) is recommending that doctors screen all children for snoring to determine if they might be at risk of obstructive sleep apnea, a temporary collapse of the upper airway that occurs during sleep.

Symptoms of the condition include snoring, often with pauses, snorts or gasps as breathing temporarily stops and restarts.

“Our hope is this will raise awareness of this condition among pediatricians so more children will be diagnosed,” AAP committee chair Dr. Carole L. Marcus, director of the pediatric sleep center at Johns Hopkins University in Baltimore, Maryland, told Reuters Health.

During the past 3 years, the committee conducted a review of more than 2,000 medical journal articles to develop the first-of-their-kind guidelines on sleep apnea among children.

While about 3% to 12% of youngsters snore, about 2% are thought to have obstructive sleep apnea syndrome. If left untreated, sleep apnea can cause significant health problems such as poor growth, neurological or behavioral problems, and in the most severe cases, heart problems.

“People are familiar with this for adults, but don’t realize this is common in children because they look fine when they are awake,” Marcus noted. “People don’t think to bring up the condition of snoring.”

However, the guidelines recommend that pediatricians should ask all children and their parents whether or not the child snores. Those who do snore should be further questioned on whether the snoring is continuous, causes the child to choke or gasp, or causes labored breathing or sweating during the night.

Children who appear to be at high risk for sleep apnea should undergo nocturnal polysomnography, a laboratory-conducted sleep study, according to the AAP. Other methods, such as physical exam, taking a medical history, or videotaping the sleeping child, have not been successful in accurately diagnosing sleep apnea, Marcus said.

“We’re hoping more objective testing will decrease the number of procedures done, making sure every child that gets surgery will need it,” Marcus explained.

The most common treatment for children diagnosed with sleep apnea is surgical removal of the tonsils and adenoids, which will cure 95% of the cases, Marcus noted.

Children who are at high-risk for the procedure, such as those under 3 and those with severe apnea, should stay in the hospital overnight after the procedure so doctors can monitor the effects of swelling and medications. Those who cannot get surgery or whose surgery is unsuccessful may benefit from continuous positive airway pressure–a mask worn at night that delivers air through nasal passages.

“A lot of parents ignore snoring,” Marcus pointed out. “But snoring in children is unusual enough that they should pay attention to it and discuss it with their pediatricians.”

SOURCE: Pediatrics 2002;109:704-712.