Obstructive Sleep Apnea
Children with Sleep Apnea
Obstructive sleep apnea (OSA) affects 8% or more of children in United States. Obstruction of the airway during sleep may be much more subtle in children. Although the term obstructive sleep apnea may still be used, true apnea commonly does not occur. However, it is important to emphasize that the signs and symptoms of OSA in children are much more subtle than in adults. The obstruction will lead to a disruption of sleep or “arousal.” Snoring is a sign that disruption is occurring. Symptoms of OSA in children may consist of restless sleep, sweating during sleep, snoring, night terror, sleepwalking, bed wetting, daytime fatigue, hyperactive behavior and poor school performance due to an inability to concentrate. Children rarely stop breathing, and snoring may be very limited or non-existent. Many children only exhibit attention deficit and hyperactive behaviors such as irritability, poor attention span, lack of concentration. Some children may exhibit poor physical growth. The normal secretion of growth hormone which occurs during sleep may be disturbed. Over a prolonged period of time alteration of the growth of the face may lead to Dentofacial Deformity known as Adenoid Face Syndrome. The patient will have a long face, open bite (teeth do not come together), mouth breather with under developed lower jaw and narrow (high arch palate) over developed upper jaw (gummy smile). In any child with signs of snoring and other symptoms a full evaluation, examination and possibly a sleep study is highly recommended. A sleep study after surgery is more important in order to determine the extent of improvement from surgery.
Causes of Pediatric OSA:
- Enlarged Tonsils & Adenoids
- Nasal Obstruction (enlarged turbinates)
- Dentofacial Deformity (abnormal jaw growth)
- Congenital Birth Deformity (cleft lip & palate, Pierre Robin Sequence, Hemi Facial Microsomia, Treacher Collins)
Just as in adults the treatment is geared to the site of obstruction. Since majority of children with OSA and snoring have enlarged adenoids and tonsils the treatment is adenoidectomy and tonsillectomy. Surgery is preformed under general anesthesia in the hospital. At least one night stay is required. Although the success rate of surgery is quite high (approximately 80%), some children still exhibit residual problems. Additional treatment options such as nasal CPAP or orthodontic therapy to widen the jaw may be considered.
Radiofrequency reduction of the turbinates is preformed as an out patient majority of the times or in combination with adenoidectomy & tonsillectomy (T&A). For more information of radiofrequency reduction of the turbinates please refer to the treatment section of this website.
Children with OSA and Dentofacial deformity such as adenoid face syndrome will under go T&A as an initial therapy if not contraindicates. Orthodontic evaluation and therapy are important in this group. Patients will generally have rapid palatal expansion at the pre teen years either surgically or orthodonticlly to widen the upper jaw. This will allow for better relationship of the lower jaw to the upper jaw and increase the dimensions of the airway in the throat for improved air exchange. In the late teen years patients will the under go orthodontic therapy and corrective jaw surgery (orthognathic surgery) to correct the Dentofacial deformity and OSA. In certain conditions such as very small jaws (micrognathia) patients will need early surgical intervention to control their sever OSA from retread jaw and tongue position. The jaws are surgically moved forward with a device called distraction osteogenesis. Some of these patients will still require corrective jaw surgery in the future. Please refer to distraction osteogenesis in the treatment section for more information.
Children with congenital birth deformities of the face will require early multiple surgical intervention starting early in life to there teen years. The major brain development in children is so rapid in the early years of live that a decrease in oxygen levels will result in a major insult to the brain tissue. Recent research has shown developmental delay and low I.Q. in children with OSA which have not been treated adequately.
Download the INTERNATIONAL SOCIETY FOR CRANIOFACIAL SURGERY Presentation
INTERNATIONAL SOCIETY FOR CRANIOFACIAL SURGERY
Download the ISCFS XI INTERNATION CONGRESS Presentation
ISCFS XI INTERNATION CONGRESS