Obstructive sleep apnoea (OSA)

Evidence 

https://www.racgp.org.au/afp/2015/june/sleep-apnoea-in-the-child 

Gillian M Nixon Margot Davey 

Obstructive sleep apnoea (OSA) is a condition that causes repetitive episodes of upper airway obstruction during sleep, leading to hypoxia and/or sleep disturbance. The condition affects 1–5% of children, and peaks in the pre-school years.  

Education 

What is sleep apnoea? 

Obstructive Sleep Apnoea is when a child stops breathing due to repeated blockages to their airway while they sleep. The child is trying to breathe and often will gasp or choke to open up their blocked airway.  These blockages are usually due the tonsils and adenoids obstructing the upper airway.  

Some signs may include: 

• Snoring or noisy breathing 

• Pauses in breathing 

• Restless sleep 

• Bedwetting  

• Gasping or choking sounds 

• Trouble feeding or growing 

• Being very sleepy or irritable during the day (especially in the afternoons) 

What is the cause of sleep apnoea? 

In a child, the most common cause of sleep apnoea is blockage of the airway by tonsils and adenoids. Other risk factors are the shape of the skull and the size of the tongue e.g. a child with Down syndrome has a larger tongue that may block the airway. In children with a small or receding jaw, sleep apnoea is more common. Other high-risk groups include children who have had cleft palate surgery, as well as children with neurological problems such as cerebral palsy and muscle weakness. Allergic rhinitis causing nasal congestion can also cause sleep apnoea. 

How is sleep apnoea diagnosed? 

A doctor might suspect this if they see large tonsils and adenoids and certain symptoms are reported. This could include the child snoring, feeling sleepy and possibly having episodes of breathing obstruction. However the best way to be really sure about the problem is with a Sleep Study. Other options include validated sleep questionnaires such as the paediatric sleep questionnaire, OSA-18 and overnight pulse oximetry.  

The sleep study is conducted in a special area of the hospital. The child has some sensors and fine wires attached to the skin, which are connected to a computer which measures sleep, breathing and oxygen levels. Studies are generally done at night and none of the measurements are uncomfortable or painful and children usually manage to sleep. Parents generally stay with the child. 

How is sleep apnoea treated? 

If a child’s sleep apnoea is thought to be due to the size of their tonsils or adenoids, the first thing that is normally done is to take them out. In many cases this will cure the sleep apnoea. A trial of nasal steroid medication in cases of allergic rhinitis is also recommended 

If surgery is not an option, or despite undergoing removal of tonsils and adenoids there is ongoing obstructive sleep apnoea then CPAP- Continuous Positive Airway Pressure maybe an option. This involves the delivery of room air at a low pressure from a machine via a tube connected to a mask on the face. It only needs to be used at night and the treatment starts working straight away. With the right support, most children do well with CPAP. If the sleep apnoea is contributed to by a child’s weight, then weight loss programs are advised. 

Empowerment 

It can be scary to hear that your child stops breathing during sleep, but you are not alone and there are things that can help: 

• Ask the doctors and nurses to explain everything clearly. It’s okay to ask questions more than once. 

• If your child needs a machine or test, ask to be shown how it works. 

• You can still hold, cuddle and care for your child, even with equipment. 

• Write down your child’s signs and symptoms. Share them with your healthcare team. 

• Talk with other families who have been through this. Peer support can help. 

Useful Links 

• Raising Children Network – Baby Sleep and Breathing Issues 

• The Royal Children’s Hospital Melbourne – Sleep Disorders 

• Sleep Health Foundation – Sleep Apnoea 

• Better Health Channel – Sleep Apnoea 

Need support? NurtureConnect allows you to connect with our NurtureProgram support team, or call our 24 hour NurtureLine 1300 622 243 or join our Facebook community.

NurtureConnect