When a person dozes off, the muscles in their throat may relax to the extent that soft tissue at the back of the mouth collapses and blocks the airway. This consequently causes either a decrease or an abrupt halt in inhaling.
Adults usually take approximately 12-16 breaths per minute, whereas children have a faster breathing rate that is dependent on their age and size. Moreover, since children have smaller lungs, they are unable to hold as much oxygen in reserve. Therefore, any momentary respite from breathing can result in low levels of oxygen in their blood. Typically, they take swift shallow breaths instead of long deep ones. This can lead to an excessive amount of carbon dioxide accumulating in their blood if they suffer from sleep apnea.
Adults with sleep apnea may experience frequent interruptions to their slumber, commonly due to brief awakenings after episodes of breathlessness. This is distinct from children, who have a higher arousal threshold than adults, meaning that their pattern of sleep often appears normal regardless of pauses in breathing. If you notice your child having difficulty sustaining sleeping however, it would be prudent to seek further evaluation.
Older children and teens are more likely to suffer from excessive daytime sleepiness than younger children with sleep apnea. Conversely, inattention and/or hyperactivity may be seen in the latter.
Many children with sleep apnea have had a history of snoring. This can come in the form of loud or disruptive noises, complete cessations in breathing and even gasps for air. Whilst some cases may be easily identifiable, it could be something less noticeable such as continuous partial obstruction without any arousals or pauses. The child's body may move as an involuntary response to these disturbances, often resulting in an agitated sleep.
Younger children tend to have more flexible rib cages, which can cause breathing difficulties that produce abnormal movements in the chest and abdomen. Parents may observe their child putting in extra effort to breathe. This type of breathing is not considered normal for kids over three.
In some cases, untreated sleep apnea can eventually cause a person to develop a “funnel chest”, which is characterized by the sinking of the sternum. This results in an indentation in the chest wall.
Children with sleep apnea may be restless in bed, changing sleeping positions frequently. This can include sleeping in odd postures such as sitting up or extending the neck to promote easier breathing. Excessive perspiration during sleep and morning headaches are also associated with the disorder, as are bedwetting episodes and episodes of sleep terror.
Children suffering from sleep apnea generally breathe through their nose while awake, but mouth breathing is not uncommon. Additionally, they may experience repeated upper respiratory infections and have difficulty swallowing due to overly large tonsils.
Sleep apnea can manifest in early years but may go unnoticed for some time. There are signs that a child’s growth rate is hampered by sleep apnea, however this can be reversed following successful treatment. It is also possible that untreated sleep apnea can increase the risk of high blood pressure.
Cognitive and behavioral problems are common in children with sleep apnea. These problems may include:
- Aggressive behavior
- Attention-deficit/hyperactivity disorder
- Delays in development
- Poor school performance
- Mood changes and poor choices