According to researchers at the Children’s Hospital of Eastern Ontario, the incidence of obstructive sleep apnea, a serious sleep disorder that can lead to chronic health conditions, is on the rise in children. The problem has become so great that medical professionals have had to develop a new method of screening for the disorder in children so that they can more efficiently determine which patients should be given priority in treatment.
Obstructive sleep apnea causes air flow to stop entirely or be seriously disrupted while the patient is asleep. It is a chronic condition that occurs when the muscles of the throat collapse and prevent air from flowing as it should. Though many people who observe sleep apnea think that the sufferer is simply snoring loudly, the explosive sounds that are characteristic of the condition are actually the body awakening itself and gasping for air. Obstructive sleep apnea has been linked to heard disease, high blood pressure, diabetes and stroke, and was once thought to be strictly limited to adults, but it is being diagnosed with great frequency in children. A rise in childhood obesity is thought to be the cause, and in addition to creating a risk of the above-mentioned health issues, in children sleep apnea also contributes to problems in learning as well as in behavior.
As a result of the increase of cases being seen, as well as in the seriousness of those cases, doctors at Children’s Hospital of Eastern Ontario have taken to measuring the circumferences of children’s necks when they are brought in for diagnosis. They do this because they have found that those children whose neck measurements are above the 95th percentile for their gender and age are at the greatest risk for being diagnosed with the condition. As a result of these findings, principle investigator Dr. Sherri Katz and her colleagues have introduced a new growth curve specifically for screening purposes.
According to Dr. Katz, who has been doing sleep research at the facility for ten years, it is becoming increasingly important to screen children to determine whether they might have obstructive sleep apnea, not only because the disorder can cause so much damage but also because the waiting list for the required diagnostic procedures has become so long. She says that the number of sleep lab tests being ordered for children has increased tenfold over the last several years, resulting in waiting lists that extend for more than two years. What she is seeing at her facility is true throughout Canada – physicians and sleep laboratories are unable to meet the demand for testing. By using the screening test she feels that physicians will be able to make sure that those who are at greatest risk get seen by sleep specialists and monitored in a sleep lab that much sooner.
“The gold standard test is still a sleep study, but because the wait is so long we needed something quick and reliable to help bump kids up the priority list or to better understand who is at the highest risk.” Katz went on to say that if not detected, obstructive sleep apnea “sets kids up for cardiovascular disease, diabetes and other comorbid conditions down the line.”
One positive that has come out of the realization that the sleep disorder is on the rise in children is that it has helped physicians to realize how strong the link is between obstructive sleep apnea and obesity. The relationship has become so clearly established that at her facility when children are seen in the obesity clinic, obstructive sleep apnea is on the checklist of items that are required to be screened.
Though the new screening tool is used on both boys and girls, Dr. Katz says that the correlation between neck size and risk for obstructive sleep apnea is far greater in male patients ages twelve and older. The girls of the same age did not have as close a correlation between the size of their necks and their risk for the condition, , and there was also no correlation of import found between risk and body mass index.
One of the most interesting things that physicians and sleep researchers are finding is that it is becoming more and more apparent that when children are diagnosed with obstructive sleep apnea it can lead to serious consequences if left untreated. Though most people thought that it was only adults that could develop severe health conditions as a result of the disorder, they are now finding that the “consequences start in early childhood.” They are also finding that those children who have been treated for the condition have shown remarkable improvement, particularly in their behavior. Children who have begun using a continuous positive airway pressure (CPAP) mask when they sleep have reportedly shown dramatic improvements in the way they feel and the way that they act.
“Certainly I hear time and time again that the children feel better, that they are doing better in school, they have more energy in the day time, they have stopped taking naps during the day. Treatment can make a huge difference in patients’ health and quality of life.”
For most obese children, the use of the CPAP mask is the treatment of choice for obstructive sleep apnea, though younger children generally undergo surgery to remove their adenoids and tonsils.
The hospital is devoting many resources to the study of obstructive sleep apnea in children, and is currently conducting a study that monitors various measurable changes that occur in those who have been treated, including shifts in blood pressure, blood sugar levels and quality of life. It is hoped that the unique ability to provide treatment for obstructive sleep apnea in conjunction with obesity treatment will also make a considerable improvement in the quality of life and health in these children.