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Wednesday, April 22, 2020

Sleep Disturbances in Children – Pediatric Obstructive Sleep Apnea

 
Enlarged adenoids in children
Enlarged adenoids in children
Sleep disturbances in children

“Sleep-disordered-breathing(SDB)” is a common phrase that is used for disturbances in breathing throughout sleep. 

Sleep-disordered breathing can vary from regular heavy snoring to OSA, a state that involves continuous instances of complete or partial obstruction of the air passage throughout sleep time at night.

Whenever a child’s respiration is disturbed while sleeping, the body assumes it as a harsh incident. The heart beats slows down, BP is elevated, the brain gets alert and sleep is disturbed. The levels of oxygen can also fall down in the blood.

Roughly about 10% of children are a regular snorer and more or less 2 to 4 percent of the pediatric populace is suffering from obstructive sleep apnea

New research points out that snoring or sleep-disordered breathing will possibly ground to lots of similar issues like obstructive sleep apnea in children.
Is it possible that my child is also suffering from OSA?
Heavy snoring is a very clear indication of disturbed breathing in sleep almost every night. Absolute obstruction of breathing can interrupt the snoring together with snorting noises and gasping that result in waking up from sleep.


Because of the shortage of sound sleep, the victimized child may seem to be peevish, drowsy throughout the daytime, or finding it hard to concentrate while in school. 

Hyperactive or busy attitude possible will as well be seen. Children having OSA are also found in the habit of bed-wetting.

Enlarged adenoids and tonsils are also frequent physical reasons for the narrowing of the airway concerning SDB. Obese children are also at the threat of sleep-disordered breathing due to deposits of fat in the region of throat and neck, which also grounds the narrowing of the air passage. 

The abnormalities in children such as cerebral palsy, neuromuscular deficits, or tongue or jaw issues can also be a cause of SDB.  Following are the possible upshots of SDB in children:
Heart-related- Children suffering from OSA are at higher risk of hypertension, heart-related, and lung issues.

Overweight- Daytime exhaustion or battling against insulin can be a result of SBD that will reduce the bodily activities and thus become the contributing a factor of gaining weight.


Development- The development in SDB affected children decreases due to the impediment of the growth hormones.

Bed-wetting- Bed-wetting/Enuresis can be a big issue of SDB children because of the higher production of urine.

Learning and Behavior- SDB can make children inattentive, disruptive, and moody both at school and at home.

Societal- A child with SDB can snore loudly, which is troublesome for those who share his room.

How a diagnosis is made of Sleep Apnea?

SDB have to be taken into consideration in children if they snore loudly regularly, snort, thrash, or bed-wet without any reason. Other behavioral warning signs can comprise poor performance at school, misbehavior, and mood changes

It is not necessary that every child who shows behavioral or academic issues suffers from sleep disorder breathing. However, if he is snoring noisily frequently or have academic, behavior, or mood issues, SDB has to be taken into consideration.

Have your children tested out by an ear, nose, and throat specialist (otolaryngologist) if you suspect SDB symptoms in them. Every so often, doctors judge of SDB based on physical or historical analysis. 

While on some other occasions, they may refer for further sleep examination, particularly if a child is below three years of age, or is a suspect of harsh obstructive sleep apnea because of neuromuscular destruction, excessive weight, or craniofacial syndromes.
The common polysomnography is the main check-up for SDB. In this check-up, a sufferer’s body, and head are attached to the wires to observe blood oxygen levels, breathing patterns, movements of the eye, the tension in the muscles and brain waves.

This type of testing does not hurt and normally performed in the hospital or a sleep lab.  Sometimes, sleep analysis does not give accurate outcomes, particularly in children. 

However, regular sleep tests or borderline tests possibly will diagnose sleep-disordered breathing based on clinical assessment and parental explanations.
How sleep-disordered breathing is treated?

The general reason for sleep-disordered breathing in children is enlarged adenoids and tonsils. So, surgery is carried out to remove the enlarged adenoids and tonsils as a first-line cure for SDB. 

Every year in the United States, more than half a million of tonsils and adenoids surgeries are carried out, and most of them are to overcome SDB. 

A lot of children display considerable progress in their behavior and sleep patterns after these surgeries.

Since, the surgery has its consequences, therefore, every child who snores is not sent for tonsils and adenoid surgical procedures. 

The possible issues that go side by side with surgery are issues with swallowing and speech, infection, bleeding, complications in the airway or anesthesia, etc.
In case a child shows mild symptoms and his behavior and school performance are well, or his tonsils are not large and he is close to his puberty, which time adenoids and tonsils shrink frequently, it possibly will be suggested to examine the SDB child conventionally and surgical procedure should be carried out just in case the symptoms get worse.
New research has verified that a chronic SDB is seen in several children after tonsils and adenoids procedures. 

Therefore, PSG, post-operative will possibly be required after the surgery, particularly in children that show chronic SDB signs after the surgery such as neuromuscular issues, craniofacial abnormalities, or are over-weight. 

Moreover, supplementary curing, for instance, losing weight, CPAP usage, or extra surgeries will possibly be needed.

References:



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