Sleep Disordered Breathing

Sleep Disordered Breathing describes the relatively uncommon but disruptive range of conditions in which airflow through the mouth and nose is disturbed. Dr Michelle Wyatt answers your questions and explains what to do if your child is affected.

What is Sleep Disordered Breathing (SDB)?

Sleep Disordered Breathing describes a spectrum of disorders in which the airflow through the mouth, nose and upper airways is disturbed. It can range from simple snoring to more serious problems such as obstructive sleep apnoea, a problem which is more usually associated with adults.

How is it diagnosed? 

A doctor will need to examine your child and take a full medical history. A sleep study may also be undertaken to determine the nature of your child’s sleep disorder.

What is a sleep study?

Various measurements will be taken while your child is asleep, such as: oxygen levels in the blood, heart rate, the effort of breathing, brain activity and airflow through the mouth and nose.

Is snoring a problem in children?

Snoring is a noise made by vibration of the upper airways, particularly the soft palate, during sleep. It is not associated with any change in oxygen levels in the body or disruption of brain, heart or lung activity. It is thought to be harmless although some studies from the USA have suggested possible differences in behaviour and IQ in children who snore compared with those who don’t.

What is obstructive sleep apnoea syndrome (OSAS)?

This happens when there is no airflow through the nose or mouth, even though the rib cage and tummy are still moving to try and draw air in. There may be changes in heart rate, blood pressure and blood oxygen levels. Parents may notice that their child stops breathing for a few seconds, before making a loud snort and starting to snore again. This is an episode of apnoea. Less obvious signs of the problem are restlessness of sleep, sweating and waking up during the night.

How common is OSAS?

Although many children snore, only about two or three children out of every hundred have true OSAS. Boys and girls are equally affected and the peak age for problems is around three to six years. Abnormalities in the shape of a child’s face or obstructions in the upper airway make the condition more likely. Children with neuro - muscular difficulties, such as those with cerebral palsy, are more prone to the problem. The most common cause of narrowing of the upper airway is enlargement of the tonsils (which sit at the back of the mouth) and the adenoid (which sit at the back of the nose).

What problems are associated with OSAS?

Some children who are not getting good quality sleep will start to wet their bed even if they have been dry for some time. Problems can have a knock-on effect to the next day. Adults who have OSAS are classically very sleepy in the day and some children can also be like this. However, some are actually hyperactive and have difficulties with learning and concentration. Children can also fail to grow as well as they should. More serious complications include changes in the way the heart, lungs and brain function, but thankfully these are rare.

What treatment is available?

Treatment depends on the cause. Some medications can be used to clear the nose (such as steroid-based nose sprays). Excess weight in children is known to be a very important contributor to the problem and if this is an issue, it should be addressed. If the tonsils and adenoids are large, removing them often helps. There are other operations which can be considered but they are not usually appropriate unless the child has other medical problems. A very small number of older children benefit from special sleeping face masks which push air into the mouth and nose to hold the airways open.

What should I do if I think my child has SDB?

Visit your GP who can assess your child and see whether further tests or a referral to a paediatric ear, nose and throat surgeon would be appropriate.

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