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Obstructive Sleep Apnea

Obstructive sleep apnea is a condition in which during sleep there are breaths initiated by the affected child without air movement. There may be obstructive sounds associated with these breaths and retractions may be noted (skin tugging inward) above the sternum, collar bones and beneath the rib cage.

Ordinarily there is little or no blockage of airflow while the child is awake. However, during sleep the muscles of the upper airway relax resulting in a “floppy” airway. While this is true of everyone, susceptible children usually have a fixed blockage as well in the form of enlarged tonsils , and or adenoids. The combination of these fixed obstructions and the floppy airway result in complete obstruction during sleep. Occasionally a floppy airway alone, or in combination with other less common anatomic considerations results in the same symptoms.

The child will take several breaths without air movement before the brain senses that something is wrong and wakes the child. The child may stir, may not actually open its eyes, but will be in a lighter stage of sleep or frankly briefly awake. In this awake state the upper airway muscular tone increases such that there is now adequate air movement during breathing motions. The exhausted child falls back to sleep and slowly the muscular tone of the upper airway again decreases with resultant obstruction. This cycle is repeated over and over throughout the night.

During the day time the child may exhibit “excessive daytime sleepiness” due to interrupted sleep overnight, as well as other signs if adenoidal or tonsilar hypertrophy (hypertrophy =enlargement). Some of these signs include fear of eating large chunks of food (e.g. meat), hypo-nasal voice, mouth breathing, narrow face (if long term).

Sometimes the diagnosis can be made by appropriate question and answer by the physician along with a suggestive physical exam. However, videotapes of the sleep pattern may help the physician. Additionally, with the okay of a child’s pediatrician, a parent may bring a sleeping child into the office for observation and testing of oxygenation level during sleep. In questionable cases a “sleep study” can be performed which documents airflow, oxygen saturation, and sometimes excess carbon dioxide during sleep.

Treatment is removal of the obstruction (tonsils and or adenoids). Rarely , if there is no obstruction, but simply a very floppy airway velopalatoplasty (surgical tightening and reshaping of the upper airway) is performed. In children obesity is not a usual cause of obstructive sleep apnea, unlike in adults.

If untreated, untoward effects of obstructive sleep apnea include poor school performance (due to excessive day time sleepiness). An even more serious result may be “cor pulmonale” (heartfailure caused by pulmonary hypertension) – which is in turn due to low oxygenation during sleep.