Sleep Apnea In Children

Sleep apnea can affect children too

By Susanne Rust

Milwaukee Journal Sentinel
 
Life's hard enough in middle school without having to worry about snoring in history class. But such was the hardship of Kinta Cooley.

One minute she'd be awake, but a second later, she'd be slumped over in her chair, transmitting ZZZ's throughout the classroom - sending titters around the group of assembled children.

She became an object of derision and pre-teen nastiness at Glen Hills Middle School in Glendale, Wis.

Cooley, now 13, was suffering from sleep apnea, a disorder widely recognized in adults, but one that has caught little attention in the realm of pediatrics.

"It's a basic question doctors should be asking parents and pediatric patients: How is your child sleeping?" said Don Harden, a pediatric pulmonologist at the Sleep Wellness Institute in West Allis, Wis.

It is estimated that between 12 million and 20 million U.S. adults have sleep apnea. And according to Mark Stoiber, president of the Sleep Wellness Institute, several thousand die every year because of complications from sleep apnea, including an enlarged and overworked heart.

In adults, sleep apnea is generally caused by a buildup of tissue in the airway, said Stoiber.

"Think of it as like trying to suck through a straw in a thick shake," he said. "You suck and suck and the straw squeezes in on itself."

That's what happens with the airway, he said. It constricts, and as less oxygen gets to the lungs, the brain sends out an alert, rousing the sleeper into a lighter state of sleep.

In severe cases, this can happen several hundred times a night. The brain's alarm is the equivalent of a small physical nudge. In the course of a night, people with sleep apnea will have been poked by their brain so many times, they end up having gotten very little, if any, restorative sleep.

That leaves them tired during the day.

"The typical person with sleep apnea is an older man, with a thick neck, overweight, who drinks a lot of caffeine during the day. This guy might have a short fuse, a short temper. And he may doze off during work, at meetings, or while driving," said Stoiber.

Kids on the other hand, said Harden, don't have much access to caffeine. Therefore, unlike an adult who can use a stimulant all day to disguise the effects, a child will show it.

In some cases, "instead of appearing somnolent, they'll appear hyperkinetic," or hyperactive, Harden said.

But in Cooley's case the apnea was so bad that there was no hyperactivity. Instead she showed the symptoms of a pre-teen narcoleptic: falling asleep in class, at dinner, on the couch.

"She'd come home from school and take a nap," said her mom, Lisa Swift. "As soon as she sat still, she'd fall asleep."

In adults, sleep disruption can be identified by a typical pattern of snoring that includes intermittent pauses accompanied by noticeable chokes or heaves. The rib cage will expand and contract as though the sleeper were struggling for breath, Harden said. "This episode may terminate with a gasp - a sudden rush of air.

"Children don't tend to do that," he said.

Instead, their snoring is continuous. And that is a red flag.

"Consistent snoring is not normal in children," said Lynn D'Andrea, director of pulmonary services and medical director of the Sleep Center at Children's Hospital of Wisconsin.

While an occasional bout of snoring may indicate a cold or upper respiratory illness, chronic snoring should be a warning of something more serious.

One percent to 3 percent of those between the ages of 1 and 18 have sleep apnea, Harden said. Up to 8 percent can be chronic snorers. They can be underweight or overweight. And the symptoms - from overactive to incredibly sleepy - run the gamut.

Indeed, according to D'Andrea, some children diagnosed with attention deficit hyperactivity disorder might really have sleep apnea. Therefore, careful histories on both sleep habits and daytime behavior should be taken on these hyperkinetic children.

In Cooley's case, it was her mom who finally figured out what was wrong.

Swift herself had recently been diagnosed with sleep apnea. She had been falling asleep at work and, terrifyingly, while driving. She also felt she was being short-tempered and crabby with her family.

After one night at the Sleep Wellness Institute, and the constant use of a machine called a continuous positive airway pressure, or CPAP - which produces a steady stream of oxygen into the nostrils of a sleeper - she felt better. She lost weight, seemed to be able to stay awake, and just felt happier.

She wondered if apnea was affecting her daughter.

It was. One night at the clinic was all it took to realize that Cooley wasn't sleeping. She was getting so little oxygen, her brain was rousing her more than 100 times per minute.

"This was a very extreme case," Harden said.

In addition, she had very large tonsils.

Because of the apnea, and the additional pressure Cooley's tonsils and adenoids were placing on the inflow of air into her lungs, Cooley's doctors decided to remove these organs.

The removal has aided her sleep enormously, said Cooley and her mom. And although she was prescribed a CPAP to sleep with, Cooley admitted she doesn't use it much - she said it's annoying.

Since the diagnosis and surgery, her life has improved: She has changed schools, lost weight and, according to her mom, seems much happier.

When asked if that was all true, Cooley shrugged with typical adolescent nonchalance. And she seemed appalled when her mom said she has been more interested in looking pretty and wearing nice clothes.

"I don't fall asleep as much as I used to," she said. "I still don't really like getting up in the morning."

Our note: Treatments for sleep apnea in children have come  a long way.  But more research is needed and especially to see what part diet has to play. Removing tonsils and adenoids is major surgery and the complications and consequences of injuring the brain stem and the possibility of death should be considered.