Pediatric Sleep Apnea
Why Is My Dentist Asking If My Child Snores?
Some of you may have noticed that when you bring your child in for their professional cleaning and periodic evaluation, Dr. Chowning asks questions about your child’s sleep patterns. “Does your child snore? Does he grind his teeth? Does she wake up with a raspy voice or a sour stomach?” We treat adults who have obstructive sleep apnea with an oral appliance. After much study and continuing education on the subject, it was only natural that we continue our learning with research into pediatric sleep apnea. Because we have a chance to look inside their mouths (and inevitably, down their throats) a few times a year, we are in a perfect position to evaluate their airway on a regular basis.
Refresher: What is Sleep Apnea?
An apnea occurs when breathing stops for a period of time. It is generally caused by an obstruction or blockage in the airway, which causes a disruption of normal breathing. Snoring is an important warning sign because it indicates that there are excess tissues vibrating in the airway. These same excess tissues can collapse and block the airway, causing apneas to occur.
Why Is Pediatric Sleep Apnea an Important Issue?
According to a 2002 study, children with obstructive sleep apnea consume 226% more health care services than children without. According to a 2007 study, these children have 40% more visits to the hospital than children without OSA, as well as higher consumption of anti-infective and respiratory system drugs. The risks of undiagnosed sleep apnea include problems with behavior, learning and development, and in severe cases, failure to grow, heart problems and high blood pressure.
What Causes Pediatric Sleep Apnea?
Obstructive sleep apnea can be caused by anything that makes the opening of the airway (through either the nose or the mouth) smaller than it should be. Some children have very large tonsils or an enlarged tongue that blocks the opening at the back of the throat. Some may have a jaw that is smaller than normal or a palate (roof of the mouth) that is very long and hangs down into the back of the throat. Even a deviated nasal septum or an enlarged turbinate can cause a decreased amount of airflow. The shape of the upper and lower jaws are important in shaping the airway. Certain growth patterns make some children more susceptible to airway problems than others.
What are the Warning Signs of Pediatric Sleep Apnea?
- Snoring, snorting, gasping or squeaking sounds during sleep
- Restless sleep, nightmares, sleep walking or bedwetting
- Sleeping in abnormal positions with the head at an unusual angle
- Heavy, irregular breathing or mouth breathing
- Grinding teeth
- Difficulty waking up in the morning
What are the Steps in Diagnosing and Treating Pediatric Sleep Apnea?
If your child exhibits several of the warning signs and has any narrow airway risk factors, Dr. Chowning will discuss the next step in diagnosis of sleep apnea. It may involve treatment in our office as well as referral to several different doctors, including a sleep physician, an ENT, an orthodontist, an allergist and possibly 3D imaging to visualize the child’s airway. In certain cases, your child may be treated with an oral appliance that opens and shapes the airway as the child sleeps, such as the Healthy Start system. A sleep physician conducts a sleep study to gather all the data needed to diagnose or rule out a sleep-disordered breathing problem. If your child is diagnosed with pediatric obstructive sleep apnea, it is possible that an adenotonsillectomy (surgery to remove the adenoids and tonsils) could be recommended, and you would be referred to an ENT for that procedure. Because the shape of the jaws can affect the breathing space, orthodontic treatment may be necessary to change the shape of the jaws, thereby increasing the airway space. An allergist can be helpful in decreasing the size of inflamed tissues through allergy therapy.
Do you think your child may have sleep apnea?
Please contact our office at 940-382-1750 to set up a consultation. Dr. Chowning will discuss the risk factors your child exhibits and the treatment options available. He is trained in the recognition and treatment of sleep-disordered breathing in children with Healthy Start appliances. These FDA approved appliances offer a non-surgical approach to treating a constricted airway. Healthy Start appliances will be discussed in more detail in a future blog post.