Sleep Apnea in Children

Sleep apnea in children is a silent epidemic. Though not contagious, sleep apnea in children is surprisingly common and often misdiagnosed as ADHD.

Sleep Apnea in Children: Symptoms, Causes, and Treatments

It’s estimated that 20% of adults in the United States suffer from sleep apnea, many of whom are undiagnosed. However, the number of children who experience sleep apnea is likely much higher, but it’s difficult to track in people under 18 years of age. It might be scary to think of our children dealing with such an adult-sounding medical condition. Can sleep apnea cause behavior problems? Yes, sleep apnea can cause behavior problems in children. Kids with sleep apnea are much more likely to develop behavioral problems, according to multiple studies. Below, we talk about symptoms, long-term complications, causes, diagnosis, prevention, and treatment of child sleep apnea.

What is Pediatric Sleep Apnea?

Pediatric obstructive sleep apnea is a sleep disorder in which a child’s breathing is partially or completely obstructed during sleep. The condition is caused by the blockage of the upper airway while a child is sleeping, sometimes due to large tonsils or weak muscle tone. The American Sleep Apnea Association estimates that 1-4% of children suffer from sleep apnea. Of course, many go undiagnosed. I believe that number is much higher. About 50% of children suffer from teeth grinding, which can be caused by sleep apnea. Almost 40% of children grind their teeth once a week. Treating pediatric sleep apnea is likely to treat teeth grinding. Untreated grinding (like apnea) may lead to long-term complications — even into adulthood.

Signs & Symptoms of Obstructive Sleep Apnea in Children

What are the warning signs of sleep apnea? Below is a list of common warning signs & symptoms of pediatric obstructive sleep apnea:

1. Nighttime teeth grinding, which could lead to jaw soreness and teeth damage
2. Noisy breathing during sleep
3. Restless sleep
4. Excessive daytime sleepiness (this sign of sleep deprivation is more likely in adults)
5. Sleepwalking
6. Bedwetting
7. Dry mouth, which leads to poor dental health
8. Loud snoring
9. Sore throat
10. Headaches, migraines
11. Sudden awakening, accompanied by choking and/or gasping
12. Halted breathing during sleep
13. Attention-deficit hyperactivity disorder symptoms

How do I know if my toddler has sleep apnea? To determine if your toddler (or child of any age) has sleep apnea, you should talk to his or her doctor and discuss a sleep study.

Signs and symptoms of pediatric sleep apnea are a good place to start. These may be obvious, like if they snore, snort, gasp, experience restless sleep, and/or wet the bed. But some symptoms of sleep apnea in children are more subtle or vague, like headaches and attention issues. That’s why only a diagnosis by a qualified professional can confirm your suspicions for sure.

Can pediatric sleep apnea be fatal? Sleep apnea itself is not typically fatal, but sleep apnea in children does increase the risk of premature death. According to a 2013 study, children with sleep apnea are 6.5 times more likely to die prematurely than other children.

Common Causes & Risk Factors

Obstructive sleep apnea is caused by an upper airway obstruction in the back of the throat that stops the child’s breathing during sleep.

What puts my child at risk for sleep apnea? The most common risk factors for sleep apnea in children are:

Enlarged tonsils and adenoids
Down syndrome
Cerebral palsy
Sickle cell disease
Obesity, excess weight
Chronic nasal congestion, nasal allergies
Asthma
Exposure to adults who smoke
Structural jaw or airway abnormalities
Tongue tie
Family history of sleep apnea

Diagnosis

The most common test used to diagnose obstructive sleep apnea in children is polysomnography (PSG), administered during a sleep study. Since this can be a strange experience for kids, your doctor will first administer a medical history and physical examination, to make sure your child is at risk of sleep apnea.

Polysomnography means the child is hooked up to devices that monitor their breathing patterns, heart/lung/brain/muscle activity, arm/leg movements, heart rate, and blood oxygen levels while they’re asleep. A polysomnogram can rule out periodic limb movement disorder and narcolepsy. This test may be conducted at a sleep laboratory with a sleep specialist or in the comfort of your home. (I suggest having a sleep specialist administer the sleep study.)

An ear, nose, and throat (otolaryngology) doctor can rule out an anatomic blockage in the child’s throat or nasal passages.

While it can’t substitute for a diagnosis, your dentist may see signs of teeth grinding (bruxism) long before other sleep apnea symptoms appear.

If your child has symptoms of grinding, see a sleep specialist right away. This early intervention could be the difference between a long, healthy life and decades of chronic systemic illness.

This is a good reason that a dentist focused on airway health is so vital to your health!

Treatments

Possible treatment options for pediatric sleep apnea include:

1. DNA oral appliance
2. CPAP therapy
3. BiPAP therapy
4. Oral appliances
5. Adenotonsillectomy
6. Mouth taping (for older children)
7. Certain medications

1. DNA Oral Appliance

DNA is an oral device that stands for “daytime nighttime appliance”. The DNA oral appliance safely and painlessly reshapes the arches of your teeth, allowing more room for your tongue to occupy, which often resolves cases of obstructive sleep apnea. This FDA-regulated treatment option naturally, safely, gradually, and painlessly “stretches” the arches of your teeth. This allows more room for your tongue to occupy in the mouth so it doesn’t block your airway. A tongue without enough airway space is a major root cause of sleep apnea that often causes nighttime teeth grinding and other long-term health issues. Unlike other sleep apnea treatments, the DNA is a temporary treatment that corrects a root issue of sleep apnea. It is not a lifelong treatment. Many of my patients report an improved smile after using the DNA oral appliance.

2. CPAP/APAP Therapy

Continuous positive airway pressure (CPAP) is a common treatment for many conventional doctors. Using CPAP therapy, your child wears a mask during sleep that makes sure they don’t stop breathing. Many children find this uncomfortable, so it is less commonly recommended in children. One reason it is uncomfortable for adults and kids alike is the continuous pressure. This makes breathing in easier. However, it may feel like you’re breathing through a straw when you exhale. I would not suggest this therapy as a long-term solution for childhood sleep apnea since the masks can prove very uncomfortable. They may even weaken the muscles of the child’s throat. CPAP machines do not address the root cause of sleep apnea — for instance, a large tongue in a small oral cavity, blocking the airflow. APAP stands for “alternating positive airway pressure”. Children are not usually good candidates for CPAP or APAP. But it is worth noting that, sometimes, APAP machines are erroneously called CPAP.

3. BiPAP Therapy

Bilevel positive airway pressure (BiPAP) is another mask and machine, like CPAP.

Unlike CPAP, BiPAP uses two levels of pressure — high pressure when your child breathes in, and low pressure when your child breathes out. This helps the child to easily take deep breaths.

BiPAP may be a better solution for childhood sleep apnea because it may be difficult to exhale with a CPAP mask on, whereas BiPAP allows for easy inhalation and exhalation.

4. Oral Appliances

Other oral appliances besides DNA include nightguards, oral splints, mandibular advancement devices (MAD), and tongue retention devices (TRD).

Other oral appliances may manage symptoms of sleep apnea, such as teeth grinding. But these oral devices do not treat the root cause of sleep apnea. This is why the only oral appliance I recommend is the DNA.

5. Adenotonsillectomy

Adenotonsillectomy is an operation to remove both the adenoids and tonsils.

Since large tonsils and adenoids are a major risk factor in pediatric sleep apnea, this operation is quite common in children with sleep disorders.

If enlarged tonsils and adenoids are the root cause of your child’s apnea, this is probably the best treatment option for your child.

Note: An adenoidectomy is a procedure for removing only the adenoids, and a tonsillectomy is only for removing the tonsils.

6. Mouth Taping

Using specialty mouth tape (sleep strips) may help to prevent minor sleep apnea symptoms by gently training your child to breathe in and out through his or her nose, rather than the mouth. When you use mouth tape properly, you should be able to pull your lips apart with a small amount of added force. It’s not as dangerous as it may sound at first. But mouth tape can be stressful for children, especially during the night. This newer treatment method for sleep apnea helps adults breathe through your nose. Although mouth tape doesn’t prevent you from mouth breathing (which is detrimental to your oral health), it instead encourages nasal breathing. However, many experts do not recommend mouth taping for young children, particularly when they go to sleep. It’s not necessarily dangerous, but it may cause anxiety that could worsen their health conditions. I do not recommend this approach for children under 12.

7. Certain Medications

Certain medications that may help with childhood sleep apnea symptoms include topical nasal steroids, asthma meds, or botox.

These prescriptions often do not treat the root cause of sleep apnea. They only manage symptoms, so these medications should only be a temporary solution, if anything.

How do I stop grinding my teeth in my sleep naturally?

These 5 tips may help your kids stop grinding their teeth at night:

Steer clear of caffeine in the P.M. hours
Spend less time on electronics and more time outside
Take a warm bath before bed, which can relax throat muscles
Exercise (including active playtime) to reduce stress levels and encourage weight loss
Avoid airborne irritants, such as tobacco smoke, indoor pollutants, and allergens

Complications of Untreated Sleep Apnea in Children

Below are long-term complications of untreated sleep apnea in children, some of which may not occur till adulthood:

Increased risk of TMJ
More frequent cavities/tooth decay
Low sleep quality for the child and anyone they may share a bedroom with
Chronic headaches and migraines
Obesity
High blood pressure (AKA hypertension)

Increased risk of heart disease
Reflux disease
Liver problems
Type 2 diabetes
Hormonal and metabolic problems
Depression

Behavioral problems
Decreased school performance
Difficulty concentrating
Learning problems
Lower IQ

Prevention

How to prevent childhood sleep apnea:

Your child should keep active, to prevent obesity and lower stress levels — both of which are risk factors for pediatric sleep apnea.
Make sure your child doesn’t drink caffeinated beverages within a few hours of bedtime.
Your child should not spend much time around smokers.
Avoid giving your child any muscle relaxants.
At their twice-yearly visit to the dentist, make sure the dentist looks for signs of teeth grinding.
Know the signs and symptoms, so you can address sleep apnea before it causes major problems. Look for hyperactivity, sleepwalking, and bedwetting. Listen for loud snoring and interrupted breathing during sleep. Pay attention to complaints from your child about headaches, jaw pain, or a sore throat.

Childhood Sleep Apnea & ADHD

Childhood sleep apnea and ADHD (attention-deficit hyperactivity disorder) are inextricably linked. A large number of studies suggest that sleep-disordered breathing such as pediatric obstructive sleep apnea should be ruled out or treated before beginning treatment for ADHD. Up to half of children with ADHD seem to suffer from sleep-disordered breathing. Treating sleep apnea, in many cases, improves their attention and hyperactivity issues more effectively than medication. Some experts may go so far as to say that sleep apnea in children is frequently misdiagnosed as ADHD — leading to a lifetime of medication that treats a symptom, not a root cause, of hyperactivity and attention deficits. If you suspect your child of hyperactivity symptoms, talk to your dentist and doctor about signs of sleep apnea as well before determining a treatment program.

Takeaway

Pediatric sleep apnea is serious. Not only is sleep apnea in children often misdiagnosed for ADHD (and inaccurately medicated), but children with sleep apnea are at a 6.5-times higher risk of premature death. Look for signs and symptoms in your children. But there are solutions. The DNA oral appliance and lifestyle changes can work together to bring your child lifelong relief from sleep apnea and the health issues that it brings.

We love working with children! Our unique approach helps children relax and actually enjoy their trip to the dentist.

Did you know? A landmark 2006 study on 145,000 patients found up to a 21% reduction in healthcare costs associated with major diseases when oral health is improved.

Click here now to set up your appointment! Rejuvenation Dentistry’s offices are located in beautiful East Hampton and Manhattan. We empower our patients to take hold of their whole-person health, including airway-related diseases like sleep apnea.

Dr. Gerry Curatola is a renowned biologic restorative dentist with more than 40 years of clinical practice experience.

He studied neuroscience at Colgate University and attended dental school at the New York University (NYU) College of Dentistry where he now serves as Adjunct Clinical Associate Professor in the Department of Cariology and Comprehensive Care.

Sleep Apnea in Children