Sleep apnea is a disorder where breathing repeatedly stops and starts during sleep, disrupting rest and oxygen levels. While often associated with older adults, this condition affects children and adolescents as well. In young people, symptoms can overlap with other common childhood issues, leading to potential underdiagnosis and delayed treatment. Recognizing sleep apnea in this younger demographic is a growing medical focus, given the potential for long-term health and developmental consequences.
Confirming Sleep Apnea in Young People
Obstructive Sleep Apnea (OSA) affects approximately two to three percent of all children. This disorder is caused by a physical blockage or narrowing of the upper airway during sleep, leading to repeated breathing pauses. The vast majority of pediatric sleep apnea cases are OSA, similar to adults, and it is particularly common in children between the ages of two and four. Central Sleep Apnea (CSA), where the brain fails to send the correct signals to the breathing muscles, is much rarer and is usually associated with underlying medical conditions.
How Symptoms Present in Youth
The signs of sleep apnea in young people often differ significantly from the classic adult presentation of excessive daytime sleepiness. Instead of sluggishness, many children with fragmented sleep exhibit behavioral and developmental issues that can be misinterpreted as conditions like Attention-Deficit/Hyperactivity Disorder (ADHD).
Nighttime symptoms are usually the first indicators and include loud, habitual snoring. Parents may also observe gasping, snorting, or choking sounds, which are the body’s attempt to restart breathing through the obstructed airway. Other common signs include restless sleep, excessive sweating at night, and persistent mouth breathing.
The impact of poor sleep quality extends into the daytime, manifesting as hyperactivity, impulsivity, or increased aggression. Chronic sleep deprivation interferes with a child’s ability to focus and regulate emotions, leading to difficulty concentrating, poor academic performance, and morning headaches.
Younger children may show signs like bedwetting that restarts after being dry, or failure to gain weight properly (“failure to thrive”). Older children and adolescents are more likely to report feeling tired, rubbing their eyes, or falling asleep during short car rides, aligning more closely with the typical adult complaint.
Unique Causes and Risk Factors
The underlying causes of sleep apnea in young people are distinct from those in adults, where obesity is the primary driver. In children, the most frequent cause of airway obstruction is the enlargement of lymphoid tissue in the throat. Enlarged tonsils and adenoids physically block the upper airway during sleep, responsible for the majority of pediatric OSA cases.
While enlarged tonsils and adenoids are the leading cause, childhood obesity is a rapidly increasing risk factor, especially among teenagers. Excess weight contributes to fat deposits in the neck, which can narrow the airway and worsen the obstruction.
Other factors include craniofacial differences, where anatomical structures like a small jaw predispose a child to a narrower airway. Genetic conditions, such as Down syndrome or Prader-Willi syndrome, also increase the risk due to reduced muscle tone or specific facial structures. Neuromuscular conditions, like cerebral palsy, can also compromise the muscle control needed to keep the airway open during sleep.
Diagnosis and Treatment Pathways
The process for identifying sleep apnea begins with a thorough medical history and physical examination, often focusing on the size of the tonsils and adenoids. If symptoms suggest sleep apnea, a referral to a sleep specialist is the next step. The definitive diagnostic test for pediatric sleep apnea is an overnight study called polysomnography, or a sleep study.
During this overnight test, sensors are placed on the body to monitor various parameters while the child sleeps, tracking brain waves, breathing patterns, oxygen saturation levels, and heart rate. The results from the polysomnography determine the severity of the sleep apnea and guide the treatment plan.
For young children whose OSA is caused by enlarged tonsils and adenoids, the most common and highly effective first-line treatment is adenotonsillectomy, the surgical removal of these tissues. This procedure is often curative, especially for children without other complicating risk factors.
For adolescents, those who are overweight, or those who have persistent symptoms after surgery, management often involves Continuous Positive Airway Pressure (CPAP) therapy. CPAP uses a machine that delivers a constant stream of pressurized air through a mask worn during sleep, keeping the airway open. Lifestyle modifications, such as weight management, are also an important part of the treatment approach, as is the use of nasal sprays or allergy treatments to reduce nasal congestion.