Fidgety Child? Check for Apnea

Sleep apnea is a disorder that causes a person to stop breathing several times an hour during sleep. Though an estimated 18 million adults are thought to have the condition, it is often overlooked in children.

But it is not uncommon.

The American Academy of Pediatrics estimates that 2% of children experience sleep apnea, most commonly during the preschool years. The organization of 55,000 children’s health specialists became so concerned about the disorder that in April it issued treatment guidelines to its members.

Among the suggestions was that pediatricians screen all of their young patients for snoring.

Loud breathing and restless sleep are two warning signs of sleep apnea.

Nicky Ochs had always been a loud and restless sleeper, and his mother remembers listening to his snoring through the closed bedroom door.

Looking back, there were some other hints that Nicky’s nighttime breathing was not normal, but nobody ever put the pieces together. At 5, the East Granby, Conn., boy was small for his age and always a bit pale. He never slept through the night and sometimes wet the bed.

When his mother, Rosemary, was told he suffered from sleep apnea, it all began to make sense.

“I had heard of sleep apnea in adults, but it didn’t dawn on me,” Ochs said. “We just thought he was a loud breather.”

Healthy children should breathe silently during sleep, said Dr. James S. Batti, a pediatric ear, nose and throat specialist at Connecticut Children’s Medical Center in Hartford. About 5% to 10% of healthy children do snore but do not have sleep apnea, he noted.

Other clues that a child may have sleep apnea include pauses in breathing during sleep, a blue tinge around the sleeping child’s eyes and lips, growth delays, bed-wetting and hyperactive or inattentive behavior during the day.

“If there are none of these other signs, it could just be snoring,” Batti said.

Though nobody is sure exactly how many children in the United States have sleep apnea, Batti said apnea is the leading reason for surgical removal of the tonsils and adenoids. Each year, more than 263,000 children have tonsillectomies, according to data from the National Center for Health Statistics.

The problem is common in children with enlarged tonsils in the back of the throat and adenoids in the back of the nasal passage. The tonsils and adenoids are part of the lymphatic system and help the body fight infection, but often they cause more trouble than they’re worth.

When a child reaches deep levels of sleep, the airway relaxes, allowing enlarged adenoids to block the nasal passages. If large tonsils fall into the back of the throat, breathing can be obstructed.

Although sleep apnea is usually more annoying than dangerous, children can suffer serious consequences, including enlargement of the right side of the heart if the condition is severe and untreated. The enlargement can subside after tonsil and adenoid removal, Batti said.

Sleep apnea also may contribute to problems with school performance, although further study is needed, said Dr. Carl E. Hunt, director of the National Center on Sleep Disorder Research, part of the National Institutes of Health.

Hunt, a pediatrician by training, said one reason apnea has been so underdiagnosed in children is that, unlike adults, children whose sleep is interrupted by breathing lapses are not excessively drowsy during the day. Instead, he said, sleep-deprived children may be overly fidgety or active, possibly causing parents or teachers to mistakenly suspect attention deficit-hyperactivity disorder.

While the American Academy of Pediatrics recommends a formal sleep study to diagnose sleep apnea, Batti said parental reporting and an examination of the throat are usually enough to confirm the problem.

If parents are uncertain, Batti might recommend that they video or tape-record their sleeping children.

Nicky’s tonsils were so large that his parents often wondered how he swallowed, even when they had no idea that the tonsils were interfering with his breathing during sleep.

Last March, Batti removed Nicky’s tonsils and adenoids. Ochs said she noticed the results within days. His breathing became so silent that it scared her. She would watch his chest rise and fall to make sure he was alive.

Within months, the pale, scrawny boy gained 11 pounds. Now 6 and entering first grade, he has rosy cheeks and he no longer wets the bed.

“He is a changed child,” Ochs said.

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Hilary Waldman is a reporter for the Hartford Courant, a Tribune company.