Obstructive Sleep Apnea Syndrome (OSA)

Muscles become more relaxed during sleep than during the waking hours, including the muscles used to breathe.

In some children with OSA, the throat muscles relax so much that it interferes with breathing. Other children with OSA have a very narrow throat passage that causes problems with breathing during sleep.

In either case, when children with OSA try to breathe, they experience something like trying to slurp a drink through a floppy, wet paper straw. Children may make deep gasps as breathing starts, and each gasp may awaken them for a few seconds. 

Symptoms can be harder to detect in children than in adults. Symptoms of OSA include:

• Odd positions during sleep with head propped up or off the bed
• Loud and continuous snoring
• Weight loss or poor weight gain
• Stopping breathing at night for a short period − followed by snorting and gasping or completely waking up
• Sweating heavily during sleep
• Having school or behavioral problems
• Restless sleep
• Trouble waking up even though sleep should have been long enough
• Headaches during the day, particularly in the morning
• Irritable, aggressive or cranky
• Falling asleep or daydreaming in school or at home
• Bedwetting that isn’t outgrown at a typical age
• Difficulty concentrating at school
• Hyperactivity during the day

Some symptoms are similar to those described in children with ADHD, such as trouble concentrating, hyperactivity and nervousness. Because of this, some children are misdiagnosed as having ADHD when they are actually suffering from OSA. However, OSA can occur along with ADHD and even worsen ADHD symptoms.   

• Enlarged tonsils and adenoids
• Abnormality in face or jaw
• Down syndrome and other congenital abnormalities
• African American race
• Obesity
• Premature birth
• Another family member with OSA
• Sedative medications, which can promote snoring or slow breathing in children with OSA

Children / teens who snore should be screened to rule out OSA. A pediatric sleep specialist uses a test called polysomnography (PSG) to record sleep activity for at least one night in a sleep lab to see if children have OSA. During the night, the specialist places sensors on the head and body to monitor sleep patterns. The specialist also records brain waves, leg and arm movements, muscle activity, heartbeat, and breathing patterns. The sensors do not pose any danger and are not painful.

We encourage parents to stay with their children overnight to let the staff know if the study captured typical sleep and breathing patterns. The study can diagnosis OSA, determine the severity of sleep apnea and help determine the best treatment plan.

Treating OSA when it is first noticed is important for growth and development so that children do not develop further complications later in life.

Treatments we may recommend for children, depending on their condition, include:

• Surgery: If enlarged tonsils and adenoids are the cause of OSA, your doctor will recommend removing them with an adenoidectomy or tonsillectomy. Other specialized surgery may be recommended if the OSA is caused by other structural issues.
• Continuous positive airway pressure (CPAP): Provides air pressure that keeps the throat from closing during sleep. CPAP is a small mask worn over the nose during sleep. It is helpful when surgery is not possible.
• Weight loss:  If weight is the cause of OSA.  
• Medications:  Such as nasal steroid or allergy medication.

A second PSG a few months after surgery may be needed to be sure the OSA has been cured. Some surgery may stop snoring but not cure OSA.