Snoring can be a normal symptom of a cold or virus in children, but when snoring persists and children have difficulty sleeping, parents should take their children to a doctor to look for signs of more serious conditions.
Snoring occurs in about 20 percent of children and is most common among children between 2 and 6, said Dr. Marcel Deray, a pediatric neurologist and director of the sleep disorders center at Nicklaus Children's Hospital in Miami. About 10 percent of children who suffer from snoring have some sort of obstructive sleep apnea, a sleep disorder that leads to pauses in breathing throughout the night.
"That's the peak time that kids have enlarged adenoids and tonsils, which is the main cause of snoring and sleep apnea," Deray said.
Besides loud snoring, children may seem restless in their sleep, talk in their sleep, sleep in abnormal positions or sleep walk. Children may also begin wetting the bed again after not wetting the bed for months. All of these nighttime behaviors are signs that a child may need treatment for their snoring and that it could be sleep apnea.
During the daytime, children suffering from sleep apnea may wake up tired, irritable, moody and with headaches. Teachers may notice children falling asleep in class or having difficulty paying attention.
Environmental factors and allergens may also contribute to snoring. Children who are exposed to smoking can snore more. Obesity can also make children more prone to snoring because an obese person can have difficulty breathing. Children with Down syndrome or facial abnormalities are more likely to suffer from sleep apnea because they have a greater chance of having a collapsed airway.
"Some risk factors for snoring and sleep apnea may be kids that are overweight, so kids that have a body mass index over 26. You want to be a little more proactive in screening for sleep apnea," said Dr. Leonardo Torres, a pediatric sleep specialist at UHealth-the University of Miami Health System.
DIAGNOSIS AND TREATMENT
If a doctor determines that snoring may be a problem for a child, the next step is to try implementing lifestyle changes and see if the child has a cold, viral infection or allergies.
Some lifestyle changes that Dr. Nivia Vasquez, a pediatrician at Baptist Health South Florida, recommends are eating a better diet, exercising, decreasing environmental irritants and avoiding smokers.
If those changes don't improve a child's sleep or related symptoms, a doctor will then recommend a polysomnogram, which is part of an overnight sleep study. The polysomnogram measures brain activity, eye movements, heart rate, blood pressure, oxygen levels, air movement and chest movements.
Nicklaus Children's Hospital recently opened a second sleep disorders center in Weston at the Dan Marino Outpatient Center. Deray helped open the original sleep disorder center at Nicklaus in 1983.
"The sleep study entails spending one night in the lab," Deray said.
After identifying that a child has sleep apnea, the next step is to identify the cause of the sleep condition. In almost all cases, sleep apnea is caused by enlarged adenoids, soft tissue behind the nasal cavities, and enlarged tonsils. To try to fix the condition, doctors will remove the adenoids and tonsils in a surgical procedure called a tonsillectomy and adenoidectomy.
"There's no side effects other than the surgery and the anesthesia. There's a very small risk of complication," Deray said.
After surgery, children will be monitored in a sleep study to ensure the cessation of snoring and sleep apnea. If children still have difficulty breathing while sleeping after surgery, they can be put on continuous positive airway pressure, or CPAP, therapy, where an electronic device delivers air to the airways throughout the night to prevent the throat from collapsing.
It's important to treat sleep disorders such as sleep apnea in children because sleep deprivation and difficulty breathing over a long period of time can lead to permanent health problems. Permanent effects of ignoring sleep apnea include being behind in school, not reaching optimal growth, developing lung problems and behavioral changes.
"If sleep apnea is ignored and intervention isn't received, the child could end up having permanent adverse effects, such as health, behavioral or learning problems that could be prevented if they received the intervention," Vasquez said.