Obstructed sleep apnea in children occurs when your child experiences brief pauses in their breathing pattern that last from a few seconds to minutes, resulting in your child feeling tired and sleepy the next day.
There are several types of apnea in children:
- Obstructive sleep apnea: This is the most common type of apnea and is usually caused by a blockage of the airway due to enlarged tonsils and adenoidal tissue near the nasal passages.
- Central sleep apnea: This happens when the part of the brain that controls breathing doesn’t start or maintain the breathing process properly. Common in very premature infants.
- Mixed sleep apnea: A combination of central and obstructive apnea, mixed apnea is usually a sign of an immature breathing pattern and may occur when a child is awake or asleep.
A sleep medicine expert can help get to the bottom of your child’s sleep issues with an overnight sleep test called polysomnography, which will measure your child’s quality, quantity and breathing patterns during sleep.
Depending on the results from your child’s sleep study, treatments for apnea may include:
- medications: to relieve nasal congestion and allergies
- increased activity and better nutrition: recommended for overweight children
- continuous positive airway pressure (CPAP): a nasal and/or mouth mask that forces air to send oxygenated air into the air passages and lungs
- surgery: to remove large tonsils and adenoids that make it difficult to breath
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During sleep, everyone has brief pauses in their breathing pattern called apneas. Usually this is completely normal.
Sometimes, though, apneas may be prolonged and happen often, making the breathing pattern irregular and abnormal. Abnormal apnea might actually cause decreased oxygen levels in the body and disrupt sleep.
Types of Apnea
The word apnea comes from the Greek word meaning "without wind." Although it's perfectly normal for everyone to experience occasional pauses in breathing, apnea can be a problem when breathing stops frequently or for prolonged periods of time.
There are three types of apnea:
A common type of apnea in children, obstructive apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids). This is most likely to happen during sleep because that's when the soft tissue at back of the throat is most relaxed. As many as 1% to 3% of otherwise healthy preschool-age kids have obstructive apnea.
- snoring (the most common) followed by pauses or gasping
- labored breathing while sleeping
- very restless sleep and sleeping in unusual positions
- daytime sleepiness or behavioral problems
Because obstructive sleep apnea 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 ADHD actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.
Treatment for obstructive apnea involves keeping the throat open to aid air flow, such as with adenotonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP), which is delivered by having the child wear a nose mask while sleeping.
Central apnea occurs when the part of the brain that controls breathing doesn't properly maintain the breathing process. In very premature infants, it's seen fairly commonly because the respiratory center in the brain is immature.
Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.
Conditions Associated With Apnea
Apnea can be seen in connection with:
Apparent Life-Threatening Events (ALTEs)
An ALTE itself is not a sleep disorder — it's a serious event with a combination of apnea and change in color, change in muscle tone, choking, or gagging. Call 911 immediately if your child shows the signs of an ALTE.
ALTEs, especially in young infants, often are associated with medical conditions that require treatment; these include gastroesophageal reflux disease (GERD), infections, or neurological problems or cardiac disorders.
ALTEs are frightening to see, but can be uncomplicated and may not happen again. However, any child who has one should be seen by a doctor for evaluation immediately.
Apnea of Prematurity (AOP)
AOP can occur in infants who are born prematurely (before 34 weeks of pregnancy). Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his or her own breathing normally. AOP can be obstructive, central, or mixed.
Treatment for AOP can involve the following:
- keeping the infant's head and neck straight (premature babies should always be placed on their backs to sleep to help keep the airways clear)
- medications to stimulate the respiratory system
- continuous positive airway pressure (CPAP) — to keep the airway open with the help of forced air through a nose mask
Premature infants with AOP are followed closely in the hospital. If AOP doesn't resolve before discharge from the hospital, the baby might be sent home on an apnea monitor and parents and other caregivers will be taught CPR. The family will work closely with the child's doctor to have a treatment plan in place.
Apnea of Infancy (AOI)
Apnea of infancy occurs in children younger than 1 year old who were born after a full-term pregnancy. Following a complete medical evaluation, if a cause of apnea isn't found, it's often called apnea of infancy.
AOI usually goes away on its own, but if it doesn't cause any significant problems (such as low blood oxygen), it may be considered part of the child's normal breathing pattern.
Infants with AOI can be watched at home with the help of a special monitor prescribed by a sleep specialist. This monitor records chest movements and heart rate and can relay the readings to a hospital apnea program or save them for future examination by a doctor. Parents and caregivers will be taught CPR before the baby is sent home.
If You Think Your Child Has Apnea
If you suspect that your child has apnea, call your doctor. If you suspect that your child is experiencing an ALTE, call 911 immediately.
Although prolonged pauses in breathing can be serious, after a doctor does a complete evaluation and makes a diagnosis, most cases of apnea can be treated or managed with surgery, medications, monitoring devices, or sleep centers. Many cases of apnea go away on their own.