HOUSTON – Sleep apnea doesn't just affect adults.
Christina Duth thought her daughter just wasn't a morning person.
“Avery’s all over the place. She’s the bear to wake up in the morning. She’s just grumpy and everybody knows you just don’t mess with Avery,” Duth said.
Then she noticed that Avery, now 7, had a really hard time waking up, no matter the time of day.
“So it’s, like, at that point, I started noticing. I was like, OK, you can’t wake her up if she takes a nap. Nobody can wake her up. So, it’s at that point around 4 and 5 is when it’s, like, OK, it sunk in,” Duth said.
Duth is the office manager at Dassani Dentistry, which also houses Sleep Houston. It was at work where she discovered a possible explanation for what was going on with Avery.
“Dr. Dassani teaches a class (on sleep apnea), and just one day we’re sitting around, and it’s like, 'This sounds just like Avery.' All the symptoms of adult sleep apnea. We’re like, 'Surely this couldn’t be my child.' I mean, she’s a baby,” Duth said.
As a dentist who screens her patients for sleep apnea, Dassani said most parents are shocked to learn children can suffer from sleep apnea, too.
“What we do not know, or rather, we do know, there just isn’t enough awareness out there, is that kids can be affected just the same. The signs and symptoms are different,” Dassani said.
Obstructed sleep apnea happens when a person stops breathing for 10 seconds or multiple times throughout the night, which leads to fragmented sleep and grogginess and can affect health and even behavior in children.
Dassani said the tonsils can be a dead giveaway for children with sleep apnea, because they can block the child's airway while asleep.
“When we’re looking at a kid when we’re doing our cleanings or exams, I look for tonsils. Are their tonsils big? Are they blocking the airway?” Dassani said.
Once removed, some children sleep normally again.
Dassani also pointed out teeth-grinding and mouth-breathing as other typical signs she looks for when screening. And surprisingly, behavior issues in school may point to sleep apnea.
“The symptoms and signs of a kid that has (attention deficit hyperactivity disorder) and/or sleep-disordered breathing, believe it or not, are the exact same,” Dassani said.
She advises parents to have their children checked for sleep apnea before putting them on ADHD medication.
“And there’s no such thing as a bad kid. It’s just a kid that’s tired and a kid that hasn’t been able to rest, and we can help them,” Dassani said.
Dr. Mary Frances Musso is the surgical sleep director at Texas Children's Hospital. She said sleep apnea can affect children of all ages.
“Sleep apnea doesn’t have any age barrier. Infants can have sleep apnea. You can be born with sleep apnea, and we know it affects adults,” Musso said.
She said another surprising symptom parents should be on the lookout for is bedwetting, especially for those children who've been previously potty-trained.
“The medical term is enuresis, which is bedwetting. It is related to muscle relaxation, and when you go into that REM (rapid eye movement) sleep, which is your deeper sleep, you’re -- not just those bladder muscles, but you generally, all your muscles have a tendency to relax, and that’s how it plays into having sleep apnea,” Musso said.
She said that though some children's sleep returns to normal after having their tonsils and adenoids removed, children with Down syndrome have continued and higher risks for sleep apnea.
“It’s really important in those children with Down syndrome, cerebral palsy and other cranial-facial abnormalities to have another sleep study after the surgery to make sure that the sleep apnea is cured,” she said. “And as these Down syndrome kids, in particular get older, their sleep obstruction may change, so what I often see is initially it will get better, and then two to three years later, they may have sleep problems again.”
At the Texas Children's Sleep Center, one of the largest in the region, young patients undergo sleep studies where they are evaluated overnight.
“The technologist records airflow data, as well as EEG (an electroencephalograph), and that records how much the child is sleeping and the various stages of sleep," said Dr. Binal Kancherlam, an assistant professor of pediatrics at Texas Children's Pediatrics Sleep Center.
She said the results from the sleep study will determine the next plan of action. Some children, like Avery, will get a CPAP machine to sleep with at night.
“Another form of intervention we do is CPAP therapy. This involves a machine that helps to keep their airway open and help them breathe better when they're sleeping,” Kancherlam said.
Duth said the difference in Avery's personality and behavior at school since being diagnosed with sleep apnea is like night and day.
“Finding out that there was something going on, that she wasn't a bad kid, that she wasn't behaving badly,” Duth said. “She was just tired. That's what breaks my heart.”
Duth said that since using the CPAP machine, Avery has grown a lot in her height and weight and is sleeping much better. She's also behaving much better in school.
Doctors at Texas Children's Hospital strongly encourage the parents of children with Down syndrome to visit with an ear, nose and throat doctor for evaluation.
Information on scheduling an exam with the Down Syndrome Respiratory Clinic can be found here.
For more information on treating sleep disorders in children, click here.