Contd from Miami Herald
“Obstructive apnea affects 2 percent of children between 2 and 6 years old. It is more common at that age range because their tonsils and adenoids are large compared to the rest of the body and can block the respiratory tract,” Deray says. “Beginning at age 6 they start to get smaller because they are no longer as necessary for the immunologic system. The problem tends to disappear, though it could return again in their adult life.”
In adults, this condition is common among men over 50, especially if they are overweight. In children, “it is as common in girls as in boys” and can affect children who have a normal weight, Deray says.
Another important difference between adult apnea and children’s is the number of “respiratory events” used to define the seriousness of the problem, known as apnea-hipopnea index (AHI). This diagnostic method measures partial breathing obstructions — known as hipopnea — and the apneas, or respiratory interruptions, over one hour. In adults, the diagnosis is considered mild when there are from five to 15 interruptions, moderate when there are from 15 to 30, and serious when there are more than 30.
But, as Martínez explains, “the definitions of apnea and hipopnea are different in children than in adults, who tend to have more episodes. So, if a pediatric chart is not used to evaluate the episodes but the adult method of counting is used instead, most of the cases will misdiagnose the apnea’s level of seriousness.”
Another factor is that adults can have breathing interruptions of as long as 10 seconds without consequences, while in children that number goes down dramatically to three seconds.
“If the lack of oxygen generated by the apnea lasts a long period of time, it can cause damage to body organs,” says Deray, who points out, however, that “this was a much more serious problem 20 years ago, when infantile obstructive apnea was not identified as often and many children suffered from chronic lack of oxygen.”
Today, he noted, “It is much more common that frequent sleep interruptions caused by apnea generate symptoms similar to ADHD instead of the sleepiness that occurs in adults.”
Specialists recommend that parents be alert to their children’s sleeping patterns, especially if they snore.
“Most children suffering from obstructive apnea snore, though not all children who snore suffer from apnea,” Mavunda says. “It’s important for parents to listen to the rhythm of snoring, which is different in apnea patients, whose snoring is generally stronger and then nothing is heard for a while until it starts again.
“What happens in these cases is that the child’s respiratory tract is collapsing when the snoring is stronger and the brain enters an emergency mode and sends a wake-up signal. So children wake up, stop snoring for a while and later the process starts again.”
It is precisely these frequent sleep interruptions that prevent rest and cause behavioral issues. Mavunda, however, says one can confuse the symptoms of obstructive apnea with other disorders.
“Apnea symptoms are very similar to those of allergies and inflammatory processes in nasal passages,” she says. “In South Florida we have more allergens than in any other area of the country, and if the patient’s nasal passage gets inflamed by some allergy, it can get blocked and cause breathing problems while sleeping. Therefore, parents must monitor their children’s environment and make sure that there are no causes for allergies.”
If allergies are not the problem, there is a good chance that a child’s tonsils and adenoids are contributing to the condition.
“In 99 percent of the cases, apnea symptoms improve after the tonsils and adenoids are removed,” Deray says.
Such was the case with Anthony, who stopped snoring after his adenoids were removed.
“He now sleeps a lot better and gets up rested,” says his mother.
For those who continue to have problems after the toncils and adenoids are removed, there is the option of using an oxygen mask known as CPAP (continuous positive airway pressure). This guarantees the oxygen flow in the respiratory tract and prevents it from collapsing.
“But this solution is only for a minority of very severe cases,” says Martínez of Hollywood’s Regional Memorial Hospital.