Sleep apnea is a common but often misunderstood condition where breathing repeatedly stops and starts during sleep. These pauses, known as apneic events, can last for several seconds, causing a drop in blood oxygen levels and disrupting the sleep cycle. While many people associate sleep apnea with older adults, young people—from infants to adolescents—can also suffer from this disorder. Pediatric sleep apnea is a growing concern that is frequently underdiagnosed because its presentation differs significantly from the adult form of the condition.
Understanding Pediatric Sleep Apnea
Pediatric sleep apnea affects an estimated 1% to 5% of all children, though prevalence is higher in specific high-risk groups. The condition is categorized into two main types: Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA). OSA is the more common form in young people, occurring when the upper airway becomes partially or completely blocked during sleep. This blockage happens when throat muscles relax, causing tissue to collapse and restrict airflow.
CSA is less common and involves the brain failing to send correct signals to the muscles that control breathing. Regardless of the cause, these disturbances fragment sleep, preventing the deep, restorative rest necessary for a child’s health, development, and cognitive function.
Recognizing Symptoms in Children and Adolescents
Unlike adults, who typically present with excessive daytime sleepiness, young people often exhibit symptoms that manifest paradoxically as behavioral or learning challenges. A child may struggle with difficulty concentrating in school, which can lead to misdiagnosis as Attention-Deficit/Hyperactivity Disorder (ADHD). The lack of quality sleep can result in hyperactivity, aggression, or irritability rather than obvious fatigue, which masks the underlying sleep disorder.
During the night, a parent may observe loud or habitual snoring, which is a common sign of an underlying breathing issue. More specific indicators include witnessed apneic events, where breathing stops briefly, followed by a gasp or a snort as the child startles back to a shallow state of sleep. Children with sleep apnea may also demonstrate restless sleep, frequently changing positions or sleeping in unusual postures, such as propping their head up to keep the airway open.
Other nighttime signs include excessive sweating, especially around the head, and morning headaches. Chronic mouth breathing during the day, or a nasal-sounding voice, can indicate that the nasal passages are chronically congested or blocked. These observable signs and behavioral changes are direct consequences of the brain and body being repeatedly deprived of adequate oxygen and deep sleep.
Primary Risk Factors Unique to Youth
The most frequent anatomical cause of Obstructive Sleep Apnea in children is enlarged tonsils and adenoids, a condition known as adenotonsillar hypertrophy. These lymph tissues naturally grow largest in preschool-aged children, often between two and eight years old, and their increased size can physically obstruct the small airway. This structural issue is the most significant difference when comparing the pediatric condition to that of most adults.
Another factor contributing to pediatric sleep apnea is obesity, which can lead to fat deposits in the neck and throat that narrow the airway. This is a growing concern in the youth population. Certain craniofacial differences, such as a smaller jaw or mid-face, can also predispose a child to the condition by reducing the space available for the airway. Children with neuromuscular disorders or genetic conditions like Down syndrome also have a significantly higher prevalence of sleep apnea due to differences in muscle tone and craniofacial structure.
Diagnosis and Treatment Pathways
The definitive diagnosis of pediatric sleep apnea relies on an overnight study called polysomnography, which is considered the gold standard. This test is performed in a sleep lab where sensors monitor brain waves, blood oxygen levels, heart rate, and breathing patterns throughout the night. The results quantify the severity of the breathing pauses, providing objective data that cannot be obtained through a physical exam alone.
For children whose sleep apnea is caused by enlarged tonsils and adenoids, the first-line treatment is typically a surgical procedure called adenotonsillectomy. This surgery involves removing the tonsils and adenoids and is often curative, resolving the obstructive breathing in a high percentage of cases. Following surgery, patients are often reevaluated to ensure the symptoms have fully resolved.
If surgery is not an option, or if the sleep apnea persists, non-surgical interventions are used, including Continuous Positive Airway Pressure (CPAP) therapy. A CPAP machine delivers a constant stream of air pressure through a mask to keep the airway open during sleep. For young people who are overweight, weight management and lifestyle changes are also recommended in conjunction with other therapies to reduce the soft tissue bulk around the airway.