Obstructive sleep apnea (OSA)
When obstructive sleep apnea (OSA) prevents your child from sleeping and breathing normally at night, it can be understandably alarming for parents.
At Children’s Hospital Boston, we know how important it is for families to be fully informed about your child’s condition and treatment, and how OSA could affect her long-term health. We’ve provided answers to many commonly asked questions about OSA in the following pages, and when you meet with our team of doctors, we’ll be able to explain your child’s condition and treatment options fully.
What is OSA?
OSA is a type of sleep apnea. “Sleep apnea” is a common disorder in which one or more pauses in breathing occur during sleep. “Obstructive” means that these pauses happen because the upper airway is blocked.
Although a child with OSA tries to breathe during these episodes of blockage, she doesn’t get enough air. Thus, sleep is disrupted and a decrease in the oxygen content of the blood may occur.
What are the different types of sleep apnea?
A rare type of sleep apnea is called central sleep apnea:
- Central sleep apnea occurs when the area of the brain that controls breathing fails to send a signal to the muscles that control breathing. Without this signal, the body doesn’t try to breathe for brief periods of time.
- Central sleep apnea can occur in conjunction with OSA or by itself.
- Central sleep apnea can affect anyone, but it typically occurs in people with certain neurological conditions. It’s also more common in adults and rarely affects children.
- Apnea of prematurity (AOP) is a common type of central sleep apnea found in premature babies. AOP prevents a baby from taking continuous, controlled breaths. In most cases, this type of apnea is diagnosed before the newborn leaves the hospital goes away on it’s own.
How does OSA occur?
- The soft tissues in the upper airway (the mouth, nose, throat and windpipe) get sucked inward every time we inhale, resulting in airway obstruction.
- OSA usually occurs during sleep, the time when the soft tissue is most relaxed. During sleep, a child’s muscle tone decreases, allowing those tissues to fall closer together than they do when she’s awake.
- This crowding in your child’s airway means that air has less room to get through. It can also make her upper airway temporarily collapse. This is similar to what happens when you suck on a drinking straw with your finger partially covering the end: At some point, the straw collapses, so you can’t suck any air through it.
- When the lungs don’t get enough air, it can change the levels of oxygen and carbon dioxide in the blood. Your child’s body may fix the problem by partially waking up, causing interruptions in her sleep.
Is OSA harmful?
It can be. OSA means that your child isn’t sleeping and breathing well at night, so during the day, she may be unusually tired, irritable or hyperactive.
If left untreated, OSA can also have more long-term consequences, including:
- cognitive problems (learning disabilities, hyperactivity and mood disorders)
- high blood pressure
- metabolic problems or hormone imbalances
OSA is caused by the obstruction of the upper airway in the back of your child’s throat.
The most common types of blockage involve:
- enlargement of the tonsils and adenoids (the spongy, glandular tissues at the back of the throat). This is the most common cause of OSA in children.
- fat that deposits in your child’s upper airway due to obesity
OSA can also be caused by a variety of disorders that affect the structure of the jaw and face or the function of muscles, such as:
- genetic disorders such as Down syndrome
- disorders that affect the structure of the jaw and face, such as Pierre Robin sequence, Apert syndrome and Crouzon syndrome
- Nasal allergies and craniofacial conditions can also cause obstructions that lead to OSA in children.
Signs and symptoms
What are the symptoms of OSA?
A child with OSA may:
- snore loudly or have noisy breathing during sleep
- experience periods when she has a hard time breathing, which typically last six to 20 seconds and often end in a gasp, snore, snort or sigh
- sleep with her mouth open or neck extended
- have restlessness during sleep
- excessive sleepiness, irritability or hyperactivity during the day or poor school performance
- wake up with a dry mouth or headaches in the morning
- experience occasional bedwetting
If you suspect your child might have OSA, talk to her primary care doctor about her symptoms. Your doctor may refer you to Children’s for a full evaluation, which often includes a sleep study.
Questions to ask your doctor
You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.
If you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.
If your child is old enough, you may want to suggest that she write down what she wants to ask her doctor, too.
Some of the questions you may want to ask include:
- Is my child’s snoring a sign of a serious problem?
- What seems to be causing the problem?
- Are there any additional symptoms I should be on the lookout for?
- How can my child’s condition be treated?
- How could this affect my child’s long-term health?
- What do we do next?
- If a sleep study is recommended, what will happen during the sleep study? What should we do to get ready?