Sleep apnea of ​​the child: how they manifest themselves, why they come, how to intervene

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Catherine Le Nevez
@catherinelenevez
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Fonte: Science Photo Library

Children who snore, have a restless sleep, maybe urinate in bed. And that during the day they are hyperactive and irritable, with some scholastic difficulties. A variety of signals that can depend on a single problem: lobstructive sleep apnea (OSAS), a syndrome characterized by repeated episodes of sleep apnea.



These are true and proper interruptions in breathing during sleep, caused by a temporary blockage of air passage in the upper airways, those just behind the nose and mouth. These interruptions can last from ten seconds to a few minutes and can be repeated several times per hour.



The consequences of obstructive sleep apnea

If left untreated, the syndrome can lead to delays in the child's growth, an increased risk of ear infections and, in severe cases, an increased risk of diabetes, hypertension and cardiovascular diseases such as arrhythmias, atherosclerosis and the so-called cor pulmonale, an enlarged ventricle.



Symptoms


How do you know if your baby has obstructive sleep apnea? If the doctor's opinion is needed for the diagnosis, and also the result of some instrumental investigation, there are certainly some signs that may make parents suspect that something is wrong in your baby's sleep. For example:



  • snoring. As recalled by the national guidelines on the subject, just released by the Ministry of Health, this is the most common symptom in children affected by the syndrome. Obviously we are not talking about occasional snoring, which can happen for example when the child has a cold, but the usual one, which occurs almost every night (at least between a week). And even in this case it is not certain that the child suffers from OSAS. Effectively, between 3% and 21% of children snore routinely, but only 1-6% have apneas;
  • a certain "respiratory fatigue" during sleep, with the observation of episodes of apnea;
  • restless sleep, with frequent changes of position, or sleep in particular positions that facilitate the entry of air, for example when seated;
  • tendency to mouth breathing;
  • nocturnal enuresis (bed wetting);
  • headache early morning;
  • behavioral abnormalities during the day, such as hyperactivity, aggression, poor school results;
  • poor attention span and concentration.
In some cases it may be present sleepiness during the day, but it is not the norm in children with obstructive sleep apnea syndrome (unlike in adults).

Causes and risk factors


As we have said, apneas occur because there is a temporary obstruction - complete or partial - of the airways, which prevents the normal flow of air. There are various conditions that predispose to apneas, and in particular:

  • enlargement (hypertrophy) of tonsils and adenoids;
  • asthma and allergic rhinitis;
  • presence of abnormalities in the structure of the skull or face or in the arrangement of the teeth. Attention: we are not talking about deformities, but about simple individual characteristics that can favor the onset of apneas, such as a particularly elongated face, a small jaw, a backward chin, a small palate, greater crowding of the teeth in the two arches, superior and inferior;
  • obesity;
  • Down syndrome or other genetic syndromes.

What to do if you notice sleep apnea, or suspect your child has them


The first thing to do is of course contact the pediatrician, who will assess the situation, including by submitting to the parents a rather detailed questionnaire on the child's habits during sleep and wakefulness.

Furthermore, the pediatrician will advise parents on the specialists to consult, for example experts in sleep disorders, otolaryngologists or pediatric dentists. The new guidelines of the ministry emphasize the importance that the figure of the dentist can have in the path of recognition and treatment of the syndrome.

To confirm the diagnosis of obstructive sleep apnea it is best to do a instrumental examination called polysomnography. It is an absolutely non-invasive examination, which involves recording various physiological parameters of the child during a night's sleep (brain waves, oxygen saturation in the blood, chest movements, etc.). If this examination cannot be carried out, for example if the child is still very young, under the age of 3, there are others that are less complete, but which can still give important information.

How we intervene


Since there are several conditions that can facilitate the onset of apneas, treatment depends on each child, also based on the gravity of the situation. For many, the treatment of choice is represented bysurgical removal of tonsils and adenoids, an intervention now considered routine. However, this intervention is not always decisive, so experts advise to check well before the operation that there are no other anatomical factors that can predispose to apneas and, afterwards, to check with a polysomnography that the situation has actually been resolved.

As underlined by the ministerial guidelines, in some cases the processing is based on the use of dental devices that allow the correction of the anomalies involved in the phenomenon, for example devices for the expansion of the palate or the correction of the retrusion of the mandible. Since these are interventions of recent use in this area, the Guidelines suggest to contact, to carry them out, specialists particularly experienced in the management of sleep diseases with a dental basis.

In some cases, a drug treatment with anti-inflammatories. And obviously, in the case of obesity, it is necessary to try to intervene on the weight of the child.

If the situation is particularly serious - the apnea episodes last for a long time and recur often, causing the concentration of oxygen in the blood to drop - it may be necessary to resort to the so-called CPAP ventilatoria therapy, a mechanical treatment that involves applying a mask to the child's face during the night, connected to a device that pumps air into the upper airways when it perceives that breathing is blocked.

Other sources for this article: information material from the Children's Hospital of Boston; information material from the Children's Hospital of Stanford; OSAS article in pediatric age, published in the ACP 2022 Quaderni.

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Updated on 09.03.2022

TAG:
  • sleep apnea
  • child snoring
  • snoring
  • sleep disorders
  • baby sleep
  • hyperactivity
  • 6-14 children years
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