Sleep disordered breathing in kids

What is sleep disordered breathing?

 Sleep disordered breathing refers to a group of breathing abnormalities which occur during sleep. The abnormalities included in this group include:

• Snoring
• Mouth Breathing
• Pauses in breathing

Patients with sleep disordered breathing also may have some of the following symptoms:

• Excessive sleepiness
• Poor concentration
• Inattention
• Hyperactivity
• Aggression
• Depression
• Anxiety
• Bed wetting

Sleep disordered breathing is a spectrum of disease with children at one end having snoring and children at the other end having significant obstructive sleep apnoea[OSA].

How do I know if my child has sleep disordered breathing?

The best way to work out if your child has sleep disordered breathing is to watch them sleep. Wait until they have been asleep for at least 30min and then have a look at how they are sleeping. Features which you should look out for include:

• Snoring
• Pauses in breathing
• Excessively restless during sleep

Take a video recording of your child sleeping and bring it to the consultation with either Dr Dan Robinson or Dr Sam Dowthwaite.

Other features which are also associated with sleep disordered breathing include bed wetting and night terrors.

What is happening to cause the sleep disordered breathing?

Patients with sleep disordered breathing have partial or complete upper airway obstruction during their sleep. This obstruction results in a disruption in normal ventilation and sleep for the child. The obstruction causes snoring and the lack of oxygen causes the other symptoms associated with sleep disordered breathing.

The most common cause of sleep disordered breathing is tonsil and or adenoid enlargement. There are other causes of sleep disordered breathing but these are relatively rare.

Can sleep disordered breathing change the behavior of my child?

The behavior of your child can be significantly affected by sleep disordered breathing. It has been demonstrated that these patients may have some of the following behaviors:

• Increased aggression
• Overly hyperactive
• Manifest signs of depression
• Symptoms similar to ADHD
• Wet the bed – up to 50% of children with sleep disordered breathing wet the bed
• Poor memory
• Poor attention
• Poor performance at school

What can be done about sleep disordered breathing?

If your child has sleep disordered breathing then it is recommended that your child have an adenotonsillectomy. The decision to go ahead and have an adenotonsillectomy is entirely yours. It is important to understand that the operation will improve the quality of life for your child but is not mandatory. If however your child has OSA then it is strongly recommended that they have an adenotonsillectomy.

What are the benefits of an adenotonsillectomy in sleep disordered breathing?

The benefits of having an adenotonsillectomy are very significant and include:

• Increased quality of life for your child
• Improvement in sleep disordered breathing
• Improvement in behavioral parameters
• Improved school performance
• Reduction in bed wetting

What to do next?

If you think your child has sleep disordered breathing then make an appointment to see either Dr Dan Robinson or Dr Sam Dowthwaite. It is also helpful if you bring along a video of your child sleeping as well as getting a referral.

Article written by Dr Dan Robinson

Both Dr Dan Robinson and Dr Sam Dowthwaite practice evidence based medicine. The evidence and data backing up the statements made here can be accessed through the following clinical guideline link.

https://www.entnet.org/guide_lines/Tonsillectomy.cfm