Sleep apnea - Obstructive Sleep Apnea (OSA) in Children: Symptoms, diagnosis and treatment

A pause in breathing for about 10 seconds, that's what the sleep apnea is defined as

really. It's an obstruction in the air flow to the lungs and hence the oxygen supply to

the brain, so there's a pause in breathing for a few seconds. But this could be happening

for lots of episodes of sleep apnea. It could be happening during the night, during the

child's sleep here. So if it's happening a lot of times, that's a lot of oxygen deprivation

to the brain and we know that the brain cells, they die off.

That's true and people think sleep apnea only happens to big fat people. That's not true.

It's there in children and I'm sure you've talked to some of the teachers in schools

and they'll be able to tell you there's children that are not doing so well, not able to pay

attention, maybe disruptive in the classes. When you look at those children, you often

just see that they're mouth breathing children, they've retronetic faces. Ask a few more questions,

those mums will tell you those kids are moving all around the bed, they're tired in the morning

or else they're running around with too much energy and they're tired later on and they're

not able to pay attention and they don't do well in school.

Teeth grinding, the mouth open at night, the recurrent infections, chesty coughs. You may

notice your child's bed wetting or they might be waking up with nightmares quite regularly.

That's another indication because that's when the brain is really getting disturbed

because of the lack of oxygen and maybe they're not doing so well in school or they're not

able to pay attention. But sleep apnea is a big problem today and it can be happening

in your child and you may not know that.

It's not a normal thing to be happening really. If patients are having disturbed sleep or

snoring is an indicator that air flow may not be efficient to the lungs and hence the

oxygen supply again to the brain. If the oxygen supply isn't efficient, then of course brain

cells are going to be affected here and this has been shown in the MRI scans now that there

are areas in the brain that are actually obliterated and especially memory cells.

Modern research now is telling us a little bit more that these children with ADHD, in

fact it may be not really a disease but just more of a symptom of breathing disorders at

night time and their behaviour has changed and of course they're being labelled as possibly

on a spectrum and in fact it might only be actually a sleep disorder they have. If their

airways were developed at a younger age, they may not have any problems and we are seeing

that as well.

No because when there isn't an efficient oxygen supply to the brain, the brain is a very greedy

organ, it needs it. So initially it's going to instruct the cerebellum area to start,

you know, let's get the heart rate going up and the blood pressure will rise and the adrenal

glands will start producing more adrenaline. We're starting to get more sugar supply, the

diabetes is another factor that's going to be playing into any disturbance in breathing

at night time. So chronic illnesses then, irritable bowel, Crohn's disease, other things

have been mentioned. We still can't prove everything here but certainly all these patients

that tend to have sleep apnea are more prone to stroke for instance, snoring we know creates

a plaque build-up in the carotid artery and these plaque build-ups as you know can easily

just fly off and cause someone to have a stroke.

When we see children with their mouth open, the problem with mouth open is that we're

not getting the tongue up into the roof of the mouth to guide the face to grow forwards.

So what happens then is the structure is growing in a negative way. The lower jaw is beginning

to fall down and grow backwards. We've got to realise we have to have enough room in

our mouth for all the teeth that we are designed to have, which is 32 teeth later on. We also

need room for our tongue and as soon as the face is growing downwards and backwards the

tongue doesn't have enough room in there later on so it's sitting further back in the airway

and as soon as it starts to sit further back in the airway it has a negative effect in

airflow through into the lungs and the child may find that they're struggling for air at

night, they may move around the bed at night, they possibly could have sleep apnea if the

tongue is obstructing airflow at all, even for a few seconds. Our brain needs oxygen

all the time. If it's not getting it, there's going to be problems.

So if we have a tube, a breathing tube here in the throat, this is the collapsible part

of the airway. Now it's slightly supported at the back but the whole front of it is collapsible

and if you're not working those muscles and there are many muscles that I'm talking about

in this whole area between the chin, this hyoid bone and right down to the clavicle

or the collar bone and the breast bone or the sternum. If you're not working those muscles

and they're all the ones we work in myofunctional therapy, you're going to end up with flaccid

or flabby muscles and that's where you have your apneas.

The super important thing about treating children early enough is that you can guide the face

to grow forward, get the jaws further forward, improve the size of the airway and as soon

as the airway is bigger, they're breathing better, they're sleeping better, they're standing

better, they're looking better.