Feb. 10, 2012 -- Kids with obstructive sleep apnea are often tired by day, have trouble paying attention, and have other behavioral problems all because they are not getting enough quality sleep at night. A new study may help turn that around -- without surgery.
Sleep apnea is marked by pauses in breathing while asleep. This is often a result of an obstruction in the airway, such as oversized tonsils or adenoids. These pauses can occur throughout the night and disrupt sleep. Positive airway pressure (PAP) machines help keep the airways open during sleep. These machines deliver pressurized air through a mask to hold the airways in the throat open.
New research shows that this treatment can improve the quality of life and behavior issues for children with sleep apnea. The findings appear in the American Journal of Respiratory and Critical Care Medicine.
“The main message is that treatment, although it may be difficult to tolerate, can result in a significant improvement in childhood behavior symptoms and quality of life,” says researcher Carole L. Marcus. She is a professor of pediatrics at the Children's Hospital of Philadelphia.
3 Hours a Night Can Make a Big Difference
One of the issues with this treatment is that children may not want to wear the bulky mask while they sleep, but the study shows that even three hours a night is enough to make a big difference. “This was a surprise to me and made me feel better. Any use is better than no use,” Marcus says.
Surgery to remove tonsils and adenoids is typically the first step to treating obstructive sleep apnea in kids. But not all children are candidates for surgery, and for some, it may not cure the sleep apnea. Children who are obese, for example, may still have sleep apnea even after they have their tonsils and adenoids removed. Obesity is a risk factor for sleep apnea in adults and children.
Marcus says parents should have their child evaluated in a pediatric sleep center if there are concerns. If the apnea does not improve after surgery, PAP may be an option.
The new study included 52 children with obstructive sleep apnea. Children were aged 12, on average. Ten children in the study had significant developmental delays. Children used the device on average for about three hours per night during the three-month study period.
All children showed improvements in attention, behavior, sleepiness, and quality of life when they wore the mask while sleeping. The longer they wore the mask, the less sleepy they tended to be during the day, the new study shows. The improvements were seen in all children, including those with developmental delays.
Surgery Is Treatment of Choice for Most Kids With Sleep Apnea
Treating obstructive sleep apnea in kids will improve their behavior and quality of life, says Michael Rothschild, MD. He is the director of pediatric otolaryngology at Mount Sinai Medical Center in New York.
The real question is will kids wear this thing, he says. “From a practical point of view, young children are not always able to tolerate the mask. The thought of years of using the mask, especially during camp, or overnight stays is less appealing to parents and children.”
Also, PAP is an open-ended treatment. Surgery to remove enlarged tonsils and adenoids is sometimes a cure and has a high success rate. Rothschild says PAP may be more appropriate in children for whom there is not a simple fix such as surgery to remove the tonsils.
PAP does work in kids with obstructive sleep apnea, says Philip Alapat, MD, via email. He is an assistant professor of pulmonary, critical care, and sleep medicine at Baylor College of Medicine in Houston. “The results in the present study support the continued practice of attempting treatment of obstructive sleep apnea with PAP therapy in addition to the well understood therapies of tonsillectomy and adenoidectomy.”