A Good Night's Rest – Otolaryngology/ENT (Sleep Apnea)
December 22, 2008
Most parents can look forward to their homes getting quiet at night once their children are in bed. But for one family in Oceanside, nighttime had been noisy for several years. Eleven-year-old Jesus began snoring loudly at night at around the age of 5, but was just recently diagnosed with obstructive sleep apnea.
Characterized by pauses in breathing, obstructive sleep apnea is caused by complete or partial blockage of the upper airway and cessation of breathing for several seconds. While most children with obstructive sleep apnea are diagnosed between the ages of two and five, diagnosis can occur at any age.
Preschoolers make up the majority of childhood obstructive sleep apnea sufferers because their bodies are growing so rapidly, sometimes the tonsils and adenoids grow faster and larger than the child’s airway, thus causing the blockage that impedes breathing. Although being overweight can certainly exasperate the problem, it is not the main factor in pediatric obstructive sleep apnea.
For Jesus, sleep apnea had robbed him of a good night’s sleep for several years. His parents, Emma and Jesus, Sr., knew that their son wasn’t sleeping well. What they didn’t know was how serious the problem could be. Children with sleep apnea can develop heart problems, high blood pressure, behavioral problems and poor performance in school.
Often associated with adults and/or obesity, sleep apnea affects approximately two to three percent of all children. The majority of those with sleep apnea have obstructive sleep apnea. However, there are other types of sleep apnea. Central sleep apnea occurs when there is no blockage in the airway, rather the brain doesn’t signal the body to breath. Mixed sleep apnea is a combination of obstructive and central apneas. Management of each type of apnea may differ.
“It’s critical to treat obstructive sleep apnea in children as soon as possible,”said Dr. Wen Jiang, pediatric otolaryngologist at Rady Children’s Hospital-San Diego. “Unlike adults who suffer from sleep apnea, children with obstructive sleep apnea can be treated fairly easily and very successfully with surgery.”
The first line of treatment for children with obstructive sleep apnea is surgery to remove their tonsils and/or adenoids. Doctors at Rady Children’s perform approximately 1,700 tonsillectomies each year. About two thirds of those are for sleep apnea patients.
While the treatment for obstructive sleep apnea may seem routine, it’s not always easy to diagnose. The most common symptom of sleep apnea, snoring, affects approximately 10 percent of all children, so doctors have to consider other symptoms including restless sleep, sweating, bedwetting, daytime sleepiness with attention problems, and possibly even hyperactivity.
According to Jiang, the gold standard for diagnosing sleep apnea is a polysomnography or sleep study. However, for many patients the history is so chronic and disturbing for the parents, and the physical examination so clear cut, that a sleep study is not always necessary in all children to achieve a definitive diagnosis.
In diagnosing Jesus, Jiang completed a physical exam, took his history of snoring into account, listened to his parents describing his sleep patterns with frequent pauses, and considered a note that she received from Jesus’ school nurse documenting his inability to stay awake in school.
“Most of his throat was blocked because his tonsils were actually touching,” recalled Jiang. “The physical evidence combined with the parents’ recollection and a letter I received from his school nurse made obstructive sleep apnea an obvious diagnosis.”
Jesus explained that he had a hard time staying awake at school and was often sent to the nurse’s office or home for a nap during the day. In addition to nodding off during class, his grades dropped and those “Citizen of the Month” recognition certificates he had received when he was younger stopped coming.
Once diagnosed with obstructive sleep apnea, Jesus’ parents admit to being hesitant with agreeing to the surgery. They had heard from family and friends that the surgery would be difficult and that Jesus would be in a lot of pain and unable to eat after the procedure.
However after weighing the consequences that poor sleep was having on their son they opted to go forward and have Jesus’ tonsils and adenoids removed. Typically an outpatient surgery, most patients are discharged after only a few hours.
Jesus spent about five hours at the hospital and was feeling great by the time he got home. He was feeling so well that he requested a hamburger on the way home from the hospital.
Jesus, who loves to play video games and hopes to some day design his own video games, is looking forward to starting at a new school this fall. And his parents are hopeful that his grades will improve now that he is sleeping better.
“He was always a good student,” said Emma, Jesus’ mom. “But then last year his grades dropped and he was tired all the time. Since the surgery he is much better. He is calmer and we know his grades will get better.”
Originally published in Kids’ NewsDay, San Diego Union-Tribune,
October 7, 2008.