Does your child wake up with headaches? Do they persistently wet the bed or wake up at night? If so, they may be suffering from a sleep-related breathing disorder known as sleep apnea. Children who have untreated sleep apnea have irregular, obstructed breathing during sleep. This can have a profound impact on a child’s quality of life. Early diagnosis and treatment are important to prevent complications that can affect a child's growth, cognitive development and behavior.
What is sleep apnea?
Pediatric obstructive sleep apnea (OSA) is a sleep disorder in which a child's breathing is blocked repeatedly during sleep, due to narrowing or blockage of the upper airway. This can be due to overgrowth of tonsils and adenoids (lymphoid hyperplasia), changes in the size of the upper airway, and other factors that cause narrowing of the airway. Diagnosis of sleep apnea in children is typically confirmed by a sleep study (polysomnogram or PSG) or oximetry (recording of oxygen levels).
What are the symptoms?
There are differences between obstructive sleep apnea in children versus adults. While adults usually snore and experience daytime sleepiness, children are likely to demonstrate restless sleep and behavioral problems. Studies also show that children aged four or older who struggle with sleep apnea are at high risk for wetting their bed or “nocturnal enuresis.”
What to look for:
Gasping during sleep
Morning headaches
Snoring
Bed-wetting
Mouth breathing
Sleeping in unusual positions
Restless during sleep (lots of movement)
ADHD like symptoms, hyperactive
Difficulty concentrating or paying attention to tasks
Daytime sleepiness or irritability
Tongue tie
Sleep walking or night terrors
Failure to grow
What are the risks?
Obstruction of a child's airway can lead to health and growth disturbances. When airflow is restricted, a child’s breathing repeatedly stops during sleep and their brain has to work harder to take in oxygen. This causes arousal from sleep, and this breathing sequence can have significant consequences for a child.
While the brain is working harder to take in oxygen, it slacks off on controlling other bodily functions. This includes hormone release, arousal response, and bladder pressure. Not only does obstructed breathing affect the bladder’s ability to hold urine, it also triggers hormones that increase urine production.
From a growth perspective, obstruction of the airway can lead to mouth breathing, which has the ability to alter the way a child’s jaws grow. Other potential risks of untreated obstructive sleep apnea include failure to thrive and grow, ADHD symptoms, academic difficulties, behavioral problems and cardiovascular conditions.
The good news is that when sleep disordered breathing and obstructive sleep apnea are diagnosed and successfully treated, these symptoms usually resolve.
Risks include:
Impaired growth
Impaired cognitive function
Behavioral problems
Persistent snoring
Persistent bedwetting
Cardiovascular dysfunction
Failure to thrive
What can an Orthodontist do to help?
Orthodontists have the ability to change the size and shape of the airway in our growing patients using specific appliances. When it comes to treating obstructive sleep apnea, the ultimate goal is to improve airflow by keeping the airway open.
Your doctor may order tests to determine if airway obstruction is the culprit behind the symptoms. Treatment may include referral to an ear nose and throat (ENT) physician for potential removal of tonsils and adenoids. If oral appliances are recommended upon diagnosis, an orthodontist can design an appliance to expand the palate and nasal passages, open the airways, or position the lower jaw forward to allow maximum airflow. Commonly used appliances are referred to as a rapid palatal expander (RPE) and mandibular advancement device (MADs). Only some children benefit from such devices. Your doctor will work with you to find the most appropriate treatment for your child's sleep apnea.
It is important to note that childhood obstructive sleep apnea may resolve without intervention, as the prevalence of childhood OSA changes across periods of growth and development.
What else could be involved with airway treatment?
Dr. Godley may ask you to seek treatment with an additional team:
ENT to evaluate the tonsils and adenoids
Sleep physician
Myofunctional or speech therapist
Specialist to release a tongue or lip tie
What is the best age to bring my child in for an airway exam?
The best age for an evaluation is as soon as an airway issue is suspected - our youngest patient is 4.5 years old. The sooner we recognize an issue, the greater the chances of achieving harmonious growth and development.
At Godley Family Orthodontics, we treat with a health focus. We concentrate not only teeth straightening and correcting misaligned bites, but also healthy breathing and development.