The commonest symptom of sleep disordered breathing (SDB) / childrens snoring. Approximately 10 percent of children are reported to snore. Ten percent of these children (one percent of the total pediatric population) have obstructive sleep apnoea.
When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the nervous system is stimulated, blood pressure rises, the brain is aroused, and sleep is disrupted. In most cases a child’s vascular system can tolerate the changes in blood pressure and heart rate. However, a child’s brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky, and ill behaved.
Considerable research in the last few years has demonstrated the consequences of untreated paediatric sleep disordered breathing:
A problem if a child shares a room with a sibling and during sleepovers.
The child may become moody, inattentive, and disruptive both at home and at school. The child will lack energy.
SDB also causes increased nighttime urine production, and in children, this may lead to bedwetting.
Growth hormone is secreted at night. Low GH secretion may lead to slow growth or development.
Research suggests SDB can be associated with ADD.
The worse the child’s breathing symptoms, the greater their risk of such problems as hyperactivity, behavioral problems including aggressiveness and rule-breaking, anxiety and depression, and difficulty getting along with peers.
Newer research clearly demonstrates a lack of oxygen (and a brain blood flow) to the developing brain can affect memory, concentration and brain development. More recent research (published in late 2011) showed that the IQ difference between normal and sleep disrupted children can vary by 10 – 17 IQ points.
A child with suspected SDB should be evaluated by an Ear, Nose & Throat surgeon. Not all children with snoring will have large tonsils and adenoids, so a thorough history and examination will be required. If appropriate, your ENT surgeon may recommend a sleep study (usually organised after referral to a Paediatric Sleep Specialist, and performed overnight in a hospital).
If the symptoms are significant and the tonsils are enlarged, the child is recommended for adenotonsillectomy (removal of the tonsils and adenoids or T & A). Conversely, if the symptoms are mild, academic performance remains excellent, the tonsils are small, and puberty is eminent (tonsils and adenoids shrink at puberty), it may be recommended that SDB be treated only if matters worsen.
For some patients, a surgical procedure to remove the tonsils (and adenoids if they cause health issues) is required, which requires a stay in hospital. The tonsillectomy or adenotonsillectomy surgery is minimally invasive, performed through the throat and with cameras through the nose, and requires a general anaesthetic. An overnight stay in hospital is required i your child is under 4 years of age.
If your child is over the age of 4 then often the procedure can be performed as a day surgery procedure. A variety of tools may be used to remove the tonsils and/or adenoids, including harmonic scalpel, plasma dissection, cold dissection, laser and electrocautery. Your surgeon will decide which is the best option for your particular case.
Many patients require around 2 weeks off either school or work to recover from the surgery, with post-operative pain the most concerning symptom.
Occasionally, additional surgery to adenotonsillectomy, such as turbinate cautery (reduction or turbinoplasty) may be recommended to improve nasal airflow and the success of the surgery.
Adenotonsillectomy (+/- turbinate reduction) achieves an 85 to 95% percent success rate for childhood SDB. A failure rate is due to either adenoid re-growth, allergic rhinitis (hay fever) or immature brain triggering mechanisms for breathing.
Your Ear, Nose and Throat surgeon is the best person to speak to about surgery including the benefits and risks.
Video by Associate Professor Nirmal Patel.