Children's Hospital Colorado

Obstructive Sleep Apnea (OSA)

What is obstructive sleep apnea and sleep-disordered breathing?

Obstructive sleep apnea (OSA) is defined as pauses in breathing that frequently occur with snoring or gasping. Although it is normal for everyone to experience occasional pauses in breathing, OSA can be a problem when breathing stops frequently or for prolonged periods of time. OSA can cause a child's oxygen levels to drop because of disrupted breathing.

Sleep-disordered breathing (SDB) is a term that is used to describe all types of breathing problems that cause decreased airflow. This decreased airflow disrupts sleep quality or sleep time by causing lots of "arousals" or awakenings from sleep.

What causes obstructive sleep apnea?

The most common associations of obstructive sleep apnea in children are large tonsils and adenoids. Large tonsils and adenoids can become a problem when a child's throat relaxes during sleep because they can block air flow. Some kids with large tonsils and adenoids don't have OSA, so the tonsils don't "cause" OSA, but they contribute to it.

We think that children with OSA have problems with muscle tone that keep the throat open during sleep, even though they seem to have normal tone during the day. Other causes of OSA include obesity, craniofacial abnormalities and decreased muscle tone that can occur in children with complex medical conditions.

Who gets obstructive sleep apnea?

OSA occurs in 1% to 5% of all children.

What are the signs and symptoms of obstructive sleep apnea?

  • Labored breathing while sleeping (a pause between breaths, gasping for a breath)
  • Very restless sleep and sleeping in unusual positions
  • Bed wetting
  • Sleepwalking
  • Night terrors
  • Chronic mouth breathing
  • Daytime sleepiness or behavioral problems
  • Poor weight gain, failure to thrive

Because OSA may disturb sleep patterns, these children may also show continued sleepiness after waking in the morning, and tiredness and attention problems throughout the day. Sometimes apnea can affect school performance. One recent study suggests that some kids diagnosed with attention deficit hyperactivity disorder (ADHD) actually have attention problems in school because of disrupted sleep patterns caused by OSA or other forms of sleep-disordered breathing.

What tests are used to diagnose obstructive sleep apnea in children?

If your child has any symptoms of sleep-disordered breathing, the first step is to discuss the symptoms with a doctor. The doctor will examine your child's tonsils and take a thorough sleep history.

The doctor may order a sleep study to obtain more information about your child's sleep. An overnight sleep study is also called a polysomnogram (PSG). A sleep study is the best way to diagnose OSA and needs to be ordered by a medical provider. During the sleep study, your child's breathing is monitored closely to capture any signs of sleep-disordered breathing. The doctor will use the results of this study along with information from the exam to determine your child's treatment.

How is obstructive sleep apnea treated?

The treatment for OSA and sleep-disordered breathing depends on the cause. If needed, surgery to remove the tonsils and adenoids can cure some children. The success of this procedure depends on many things. Healthy children under 7 years old who are not obese have better surgical success. Obese children are less likely to be cured.

If surgery is not an option, treatment for obstructive apnea involves keeping the throat open to improve air flow with a device called continuous positive airway pressure (CPAP). During CPAP treatments, a child wears a nose mask that supplies extra air to keep the airways open. Other treatment options include maxillary expanders and oral appliances, such as mouth pieces. These treatments are prescribed by a dentist or orthodontist.

Some children may need therapy to tolerate CPAP therapy. Our sleep team has a desensitization therapy program to help these children.

Why choose Children's Hospital Colorado for your child's obstructive sleep apnea treatment?

The Children's Colorado Sleep Team is an excellent resource for treating children and adolescents with OSA and sleep-disordered breathing. Our providers are internationally known for their expertise in sleep research and sleep treatments. Watch one of our physicians, Ann Halbower, MD, speak about her research on treating children with OSA.

The team is made up of sleep specialists trained in different aspects of sleep treatments:

  • Physicians who specialize in children's breathing issues and children's ear, nose and throat problems
  • A sleep-specialized psychologist
  • Two sleep-specialized nurse practitioners
  • A sleep-specialized respiratory therapist
  • A dedicated sleep nurse

We often coordinate care with other specialists and primary care physicians involved in each family's treatment. Most importantly, we have very caring staff members who are willing to listen to families and "go the extra mile" to improve sleep and optimize children's development.

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