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Obstructive Sleep Aponea in Children

Obstructive Sleep Apnoea (OSA) is a medical condition in which children have difficulty breathing when they are asleep, and may have short pauses in breathing. When children fall asleep, their muscles relax and the throat narrows. This can lead to a partially or totally blocked upper airway during sleep, especially if the adenoids and tonsils are enlarged. Once the airway is blocked, the child’s oxygen level may start to decrease and this may lead the brain to trigger the child to wake up briefly to re-open the airway. These brief awakenings can significantly disturb a good night’s sleep. 

Snoring is quite common in children – about 15 to 20 percent of children snore from time to time. OSA is less common.

How do I know if my child has OSA?

  • Snoring
  • Pauses in breathing during sleep: sometimes parents notice that their child stops breathing for short periods while they are sleeping. If you look closely, sometimes it is clear that the child is still trying to breath (their chest and tummy are still moving) but no air is going in during these periods.
    • Parents may also notice their child choking, gasping or snorting during sleep.
    • Children can often seem to be struggling or working very hard to breathe while they are asleep.
    • Children’s sleep may be restless and they may sweat more than normal.
    • Some children will sleep in unusual positions, for example, propped up high on pillows or with their neck extended. 
  • Mouth Breathing during the day or night is very common due to blockage of the nose by enlarged adenoids.
  • Children may be tired waking up or have headaches despite what seems like an adequate amount of sleep. 
  • Dark circles under the eyes (venous pooling effect)
  • Children may show the day time effects of very disturbed sleep such as difficulty paying attention, behaviour problems and learning difficulties.

What is the cause of OSA in children?

The most common cause of childhood OSA is enlargement of the tonsils and adenoid glands. Tonsils and adenoids grow most quickly in the preschool years, sometimes faster than the bones of the face, leading to airway blockage. This is usually only noticeable during sleep when the muscles of the throat and tongue relax, making the airway even smaller. Other factors that may contribute to OSA include:

  • Overweight
  • Nasal allergy
  • Hay fever
  • Down syndromes
  • Naturally smaller jaw
  • Low tongue position
  • Weakened oral muscles

What can be done to determine if there is a serious problem?

Sleep study can confirm if your child suffers from OSA. This involves monitoring a child’s sleeping and breathing patterns overnight at a sleep laboratory for one night. One parent is required to stay with their child during the sleep study.

What treatment is available for childhood OSA?

Treatment for OSA depends on the cause of the problem and how serious it is. Children with OSA who have enlarged adenoids and tonsils are usually referred to an Ear Nose and Throat surgeon (ENT) to have their tonsils and adenoids removed. This operation fixes the OSA problem in at least 80 – 90% of children who do not have other medical problems contributing to the OSA. 

Other possible treatments include weight loss for overweight children, and nasal sprays for those with nasal allergy. Nasal sprays shrink the adenoids and the swellings of the nasal linings, making it easier for the child to breath through the nose while they are asleep. If the peri-oral muscles and tongue are deemed weak, an oral-facial myologist or a speech pathologist may be involved to retrain the tongue and muscles so the child can keep their mouth closed. 

A small number of children will require a machine overnight to keep the airway open. This machine is called a CPAP machine (Continuous Positive Airways Pressure) and involves wearing a special mask during sleep.  

How can a dentist be of help?

There are many external and oral signs that suggest that a child may have troubled sleep. Dentists with special trainings in the area of sleep medicine are able to identify these tell-tale signs such as:

  • Narrowed jaw forms,
  • Dental crowdings,
  • Excessive overbite and overjet,
  • Facial asymmetry,
  • Flattened or deficient facial development, 
  • Tongue posture, tongue tie, lip ties and swallow habits
  • Muscles dysfunction around the face and lips

Children with OSA often have narrowed jaws and crowded teeth requiring orthodontic treatment. If the underlying OSA is not treated, orthodontic intervention is often difficult and the result is unstable. Once the physical obstruction such as tonsils and adenoids are removed, a dentist can start working on the tongue and muscles to help undo the crowding and further develop the narrowed jaw forms. 

Contrary to popular beliefs, you do not wait until all their baby teeth fall out before having orthodontic intervention. In fact, the best age for early orthodontic intervention and jaw developments is soon after the first baby tooth is lost! Once the child reaches double-digit in age, we find the treatment often takes longer and is less effective. 

If you think your child may be suffering from a blocked nose and is demonstrating signs and symptoms related to OSA, please contact your dentist for an early orthodontic assessment. It is surprising to some that a well-trained dentist not only looks after your child’s dental needs, but the overall general health!