Obstructive Sleep Apnea Syndrome (OSAS)

Obstructive Sleep Apnea Syndrome (OSAS)

Obstructive sleep apnea syndrome (OSAS) is a common, treatable condition. OSAS causes breathing difficulties while sleeping. While it is not uncommon for some children to snore, only a small percentage (two percent) has OSAS.

OSAS occurs in people of all ages, but children with OSAS can be harder to diagnose. Children with OSAS may snort or gasp while snoring and may “suck in” their chests. Their breathing starts and stops during sleep. This is caused by the throat narrowing or closing while they sleep. When breathing stops for short periods of time, it is referred to as apnea.

Children with OSAS have trouble sleeping at night. As a result of their extreme sleepiness, they often show behavioral problems during the day. If left undiagnosed, OSAS can lead to problems at school, and delayed growth. In extreme cases, OSAS can cause heart failure, which is a result of decreased blood oxygen levels.

Description of OSAS

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

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

In either case, when children with OSAS 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 of a Child with OSAS

Symptoms can be harder to detect in children than in adults. Symptoms of OSAS 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 OSAS. However, OSAS can occur along with ADHD and even worsen ADHD symptoms.

Factors that Increase Risk of OSAS

  • 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 OSAS
  • Sedative medications, which can promote snoring or slow breathing in children with OSAS

Diagnosing OSAS

Children / teens who snore should be screened to rule out OSAS. 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 OSAS. 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 OSAS, determine the severity of sleep apnea and help determine the best treatment plan.

Potential Treatments for OSAS

Treating OSAS 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 OSAS, your doctor will recommend removing them with an adenoidectomy or tonsillectomy. Other specialized surgery may be recommended if the OSAS 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 OSAS.
  • Medications: Such as nasal steroid or allergy medication.

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

Last Updated 10/2020

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