Pediatric sleep disordered breathing (SDB)

What is pediatric sleep disordered breathing (SDB)?

A child can stop breathing during sleep if something is blocking their air flow. This causes oxygen levels in the body to fall, triggering the brain to wake and take a breath. This condition is known as obstructive sleep apnea (OSA).

This may happen for a few seconds at a time and occur multiple times during a sleep cycle. The disorder can be dangerous and lead to complications, including behavioral, heart, and lung problems, or in rare instances, it can be life-threatening.

What are the different types of pediatric sleep disordered breathing (SDB)?

• Central sleep apnea (CSA) -  a rare condition that occurs when the part of the brain in charge of breathing doesn't work properly. It is most often found in infants.

• Obstructive sleep apnea (OSA) - this is by far the most common type of sleep apnea. OSA is the result of a blockage in the back of the nose or throat. It may be due to enlarged tonsils, an oversized tongue or a small or collapsed airway.

• Mixed sleep apnea - this is some combination of central and obstructive sleep apnea.

What are the signs and symptoms of pediatric sleep disordered breathing (SDB)?

Loud snoring is the most prevalent symptom of sleep apnea in children, but most snoring is not caused by the condition. In other words, many children snore but most of them don't have sleep apnea. Symptoms of obstructive sleep apnea in children are dependent on the child's age, as outlined below.

Symptoms in infants (birth to 1 year):

• Breathing through the mouth only

• Cyanosis (blue or gray skin or fingernails)

• Choking or gurgling sounds

• Daytime sleepiness

• Difficult to wake in the morning

• Failure to thrive

• Have patterns of repeated pauses in breathing that last less than or longer than 20 seconds

• Have related problems, such as low oxygen or a slow heartbeat 

• Have needed resuscitation or other urgent care

• Snoring 

Symptoms in children older than 1 year:

• Behavioral and attention problems

• Breathing that stops for a few seconds at a time during sleep

• Breathing through the mouth only

• Daytime sleepiness

• Difficult to wake in the morning

• Gasping noises during sleep

• Hyperactive behavior when awake

• Irritability from lack of quality sleep

• Loud breathing during sleep

• Restless sleep (moves around a lot)

• Snoring 

• Unusual sleeping positions

• Wetting the bed

How is pediatric sleep disordered breathing (SDB) diagnosed?

If you suspect your child may have a sleep disorder, you should see a doctor immediately. Sleep disorders can lead to neurological and cardiovascular problems later on.

Your pediatrician will ask if you have a family history of sleep apnea. He will then perform a physical exam to look for obstructions that might cause breathing difficulties. These might include things such as enlarged tonsils or narrow airways. If the doctor suspects sleep apnea, they may recommend a sleep study.

• Sleep study - A sleep study may occur at a lab that uses special technology to monitor your child’s behavior while sleeping. More often, your doctor will order a device such as an actigraph to track your child’s sleep patterns. The watch-like instrument is non-invasive and provides specialists with data they need to recommend appropriate treatments.

What are the causes of pediatric sleep disordered breathing (SDB)?

Obstructive sleep apnea (OSA) may happen because something is blocking the upper airway, such as enlarged tonsils or adenoids. It may also happen if the muscles in the back of the throat relax and collapse during sleep. 

Infants (birth to 1 year) are more at risk for OSA due to their tendency to put items in their mouth and their smaller, and sometimes underdeveloped, airways. 

Risk factors

• Being overweight 

• Cerebral palsy (CP)

• Cranio-facial defects (problems with the mouth, jaw or throat)

• Down syndrome 

• Family history of sleep apnea

• Large tongue

• Putting objects into mouth

• Tumor or growth in the throat

How is pediatric sleep disordered breathing (SDB) treated?

Though rare in children, sleep-disordered breathing (SDB) disorders can be serious. Left untreated, obstructive sleep apnea (OSA) can lead to heart arrhythmias, high blood pressure, heart failure or even stroke.

If your child's doctor diagnoses an SDB, treatment will depend on both the condition and the symptoms. The intent of any treatment is to keep your child’s airway open so they keep breathing while asleep.

• Continuous positive airway pressure (CPAP)

• Dietary Changes

• Exercise

• Mouthpieces can help align a child's jaw so that she is able to breathe easier.

• Surgery