Children - snoring, sleep apnea

Snoring in children is a fairly common phenomenon that parents report. In one study conducted in Chandigarh, India for children between 3 - 10 years, 6% of parents reported this problem in their children¹.

Snoring occurs when the passages of air flow (nose, mouth, throat etc.,) are constricted or blocked due to various factors. The resulting vibrations of different parts in the air passage, when air is inhaled or exhaled, causes the snoring noise. 

What causes snoring?

• Colds and nasal congestion
• Obesity is also a cause. Excessive tissue around the throat area puts pressure on children's throats when they sleep, thus constricting the air passage. Talk to a doctor if you feel this is the case. Often, the child may have to be put on a stricter physical regimen combined with a controlled diet. to lose weight.
• Nasal obstruction caused by a deviated septum. The septum is the cartilage that separates the nose into nostrils. It is supposed to be in the middle but can sometimes be shifted or bent, resulting in obstructions in your nostrils. Significant deviations can be corrected by surgery.
• Sleep apnea

Sleep apnea

Sleep apnea is a condition that not only causes snoring but also interrupts breathing. This can be dangerous as it can pause breathing to stop for a few seconds, reducing the supply of oxygen to the body.

Symptoms (If you observe any of these symptoms, talk to your paediatrician immediately)

• Very loud snoring
• Makes gasping noises to recover his breath, during sleep
• Awakens frequently to catch her breath, resulting in interrupted sleep
• Sweats profusely in her sleep
• Headaches in the morning
• Interrupted sleep may be causing one or more of the following
  • General exhaustion throughout the day
  • Sleepiness throughout the day
  • Irritability
  • Lack of concentration (resulting in poor academic performance)

Often sleep apnea is caused by an obstruction. Called Obstructive Sleep Apnea (OSA), it is often caused by enlarged tonsils or adenoids.

Tonsils are a small mass of tissue located on either side of the throat, towards the back of the mouth. Tonsils are visible to the naked eye if a child opens their mouth wide enought. Adenoids are also a small mass of tissue in the back of the nasal cavity and cannot be seen. When these tissues get enlarged, they block the air passage and cause OSA. When they fully block the passage, the sleeping child may not be able to take in a strong breath immediately, to overcome this block, thus causing interruptions in breathing and breathlessness. 

OSA is usually cured by 

• Surgical removal of the tonsils and/or adenoids
• CPAP (Continuous Positive Air Pressure) - In this, the child wears a mask connected to a machine that provides the air pressure the child needs to push the air past the blockages.  It can be uncomfortable and difficult for a young child to use.

Sometimes sleep apnea is caused by a neurological problem. Called Central Sleep Apnea (CSA), it is caused because the parts of the brain that control breathing during sleep, occasionally fail to trigger breathing. Because the sleeping child does not even attempt to breathe, breathing is interrupted. This is not very common.

Also see

• Common sleep problems in young children
• Teeth grinding (Bruxism)

References

1. Bhavneet Bharti, Prahbhjot Malhi and Sapna Kashyap, "Patterns and Problems of Sleep in School Going Children", Indian Pediatrics 2006; 43:35-38