Sleep apnea in children: what it is and how to identify it – 06/21/2022

If your child snores, has restless sleep, difficulty concentrating and poor school performance, mood swings and spends a restless day, beware: he may have obstructive sleep apnea, a disorder much less prevalent in children than in adults. , but that if not diagnosed and treated properly, it can cause health problems, such as high blood pressure and risks of cardiovascular diseases, and even affect the child’s growth. That’s why it’s important for parents to be aware, so that the diagnosis is made as soon as possible.

According to the Brazilian Society of Pulmonology and Tisiology (SBPT), it is estimated that about 10% of children snore and, of these, 1% to 3% have apnea and poor quality sleep. In adults, this number exceeds 30%. But what is obstructive sleep apnea? “These are recurrent respiratory pauses that occur while the person sleeps, blocking the passage of air to the lungs. The person stops breathing a little and comes back. Stops and comes back”, explained Leonardo Goulart, a neurologist specializing in sleep medicine at Hospital Israelita Albert Einstein.

Goulart explains that the recurrent interruption of breathing during sleep has two basic consequences: the first is that blood oxygenation is oscillating, which puts the brain on alert. When alert, the brain causes micro-awakenings, interrupting sleep. One of the many systemic consequences of this phenomenon can be the reduction of growth hormone production – which can affect the proper growth of the child. “This is one of the important issues because sleep apnea reduces the levels of growth hormone. There are many studies on this in adolescents, but when treating apnea the levels return to normal”, said the neurologist.

The second consequence of the constant pauses in breathing is that sleep becomes insufficient because it is very fragmented, causing impacts the next day, such as changes in behavior, irritability and learning deficits. “In addition, another important impact of sleep apnea, which is more studied in adults, but can have an impact on children, is the metabolic alteration, with dysfunction of hormones that coordinate our metabolism, regulate hunger and fat storage. . This can lead to overweight, obesity and other changes”, warned the doctor.

The diagnosis of apnea is usually clinical, but in some specific cases it can be confirmed by polysomnography (a test that assesses the quality of sleep). “[O diagnóstico] It often takes longer than it should, but increasingly, sleep medicine knowledge is becoming commonplace in medical practice. Nowadays, pediatricians often ask about the child’s sleep quality at the appointment. The diagnosis is more advanced, but it still needs to be faster”, ponders Goulart.

Structural changes for treatment

The treatment of apnea in children is basically structural. At first, if the child is obese, losing weight can be effective. Changing the sleeping position can also help (putting the child to sleep on his side instead of on his back). If these actions do not work, you may need to intervene with surgery to remove the tonsils and adenoids (when applicable) or the use of CPAP (equipment that pushes air into the lungs through a mask fitted over the nose overnight). , preventing breathing pauses from occurring during sleep).

“In children, facial development and growth alone can help to reduce apnea. So, the use of CPAP is usually for a short time and soon the child improves. The difference is that the adult cannot use the equipment for a short time. period because there is still no other solution”, highlighted the neurologist.

Special focus for children

To help parents and children identify the problem, Instituto do Sono, with the support of AFIP (Association Fund for Assistance to Research), launched an edition of the Dona Ciência comic book dedicated to the subject. The magazine aims to provide scientific dissemination material with simplified language in a playful way, with a special focus on children, but not just for them.

“At Dona Ciência we talk about several current topics: covid vaccine, oral hygiene, breastfeeding. And we also talk about the importance of sleep, which occupies a third of our lives”, said Monica Levy Andersen, director of Education and Research at the Instituto do Sono and creator of the collection.

The SBPT listed some signs for parents to observe in their children:

• Snoring, which may or may not be loud but occurs every night
• Noisy breathing, which is worse when the child is lying on their back
• Breathing pauses and when breathing resumes, it is often with a loud snore
• Difficulty breathing through the nose
• Sleep with your mouth open (you may have your mouth open during the day)
• Agitation during the night, with changes in sleeping position
• Bedwetting, especially if the child already had prior control.

“Whenever the child’s sleep is restless and noisy, he needs to be evaluated by a professional. No snoring is normal. All noise, if it is recurrent and occurs three to four times a week, should serve as a warning sign so that parents seek specialized help”, concluded the otorhinolaryngologist Sandra Dória, a specialist in sleep medicine and a researcher at the Instituto do Sono.

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