FAQs

Sleep apnea is when a person stops breathing during sleep. It usually happens because something obstructs, or blocks, the upper airway. This is called obstructive sleep apnea (AP-nee-uh).

Obstructive sleep apnea (OSA) can make the body’s oxygen levels fall and interrupt sleep. This can make kids miss out on healthy, restful sleep. Untreated obstructive sleep apnea can lead to learning, behavior, growth, and heart problems.

When we sleep, our muscles relax. This includes the muscles in the back of the throat that help keep the airway open. In obstructive sleep apnea, these muscles can relax too much and collapse the airway, making it hard to breathe.

This is especially true if someone has enlarged tonsils or adenoids (germ-fighting tissues at the back of the nasal cavity), which can block the airway during sleep.
Other things that can make a child likely to have it include:

• a family history of OSA
• being overweight
• medical conditions such as Down syndrome or cerebral palsy
• problems of the mouth, jaw, or throat that narrow the airway
• a large tongue, which can fall back and block the airway during sleep

When breathing stops, oxygen levels in the body drop and carbon dioxide levels rise. This usually triggers the brain to wake us up to breathe. Most of the time, this happens quickly and we go right back to sleep without knowing we woke up.

This pattern can repeat itself all night in obstructive sleep apnea. So people who have it don’t reach a deeper, more restful level of sleep.

Signs of obstructive sleep apnea in kids include:

• snoring, often with pauses, snorts, or gasps
• heavy breathing while sleeping
• very restless sleep and sleeping in unusual positions
• bedwetting (especially if a child had stayed dry at night)
• daytime sleepiness or behavior problems
• sleepwalking or night terrors

Because it’s hard for them to get a good night’s sleep, kids might:

• have a hard time waking up in the morning
• be tired or fall asleep during the day
• have trouble paying attention or be hyperactive

Sleep apnea may increase sleep fragmentation, meaning that rather than experiencing the normal periods associated with each sleep stage, a child with apnea moves more frequently between deep and lighter stages of sleep. Research suggests that the longterm effects of sleep apnea in children include cognitive, behavioral, and psychosocial problems as well as growth delays and impacts on cardiovascular health.

Problems With Intellectual Development
Children with untreated sleep apnea may perform poorly on standardized tests of mental development. In a school-based study in India, children with sleep apnea were found to perform significantly less well in academic subjects than their peers. Other potential problems with intellectual development include lower scores on learning and memory metrics and on some types of intelligence quotient (IQ) tests. Children with the most severe apnea appear to also experience the most significant challenges to cognitive development.

Hyperactivity and Other Behavioral Problems
Unlike in adults—who become sleepy and sedate with sleep deprivation—children tend to become hyperactive. This may cause difficulties with attention and social behavior and may also contribute to anxiety and depression. Hyperactivity resulting from sleep apnea in children sometimes is misdiagnosed as Attention Deficit and Hyperactivity Disorder (ADHD).

An English study in the Journal of Thoracic Disease also showed that children with untreated apnea were more likely to exhibit poor social and communication skills and have difficulty regulating their behaviors. These traits are often experienced by caregivers as uncooperativeness or emotional volatility.

Inflammation
When sleep apnea continues over a long period in childhood, increasing markers of inflammation can also be found.3 Inflammation, in turn, can lead to a cascade of negative health outcomes such as compromised organ function.

Sleepiness During the Day
A child who is not getting enough restorative sleep at night could show signs of excessive sleepiness during the day.6 Babies and children need different amounts of sleep based on their age and stage, but if you notice your child napping longer or more frequently than usual or seeming tired when he or she is normally energetic, apnea could be the cause.

Issues with Growth
Sleep-disordered breathing in children is associated with negative effects on growth. Children with apnea may lose ground among their peers, or slow along their previous growth path, resulting in an inability to meet their full growth potential. This may be caused by frequent awakening from deep, slow-wave sleep which in turn could disrupt normal hormonal secretion, including growth hormones. In extreme circumstances, a child with apnea whose growth falls far below healthy levels may be diagnosed with failure to thrive.

Risk of Cardiovascular Problems
If left untreated, sleep apnea in children can result in certain cardiovascular problems. These include issues with blood pressure regulation, hypertension, and other precursors to cardiovascular events. During vigorous exercise, it’s also possible a child with untreated apnea will experience diminished cardiac performance.