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Breathless
Like a fish out of water, your
child may struggle to breathe while sleeping arents
think it is cute, even amusing the
first time they hear their kids snore. But things may
be more sinister
than they seem and it is prudent to
investigate the cause. There is a lurking bedtime monster–Obstructive Sleep
Apnea Hypoventilation Syndrome (OSAHS)–that many do not know of.
“There
is a need to educate parents on OSAHS through public forums and increased media
coverage, as few parents are aware of it,” says Dr Jenny Tang, consultant for
Respiratory Medicine Service, Department of Paediatric Medicine at KK Women’s
and Children’s Hospital (KKH).
Snoring
and OSAHS
According
to researchers, 20% of children snore occasionally and 7% snore habitually
(more than three to four days a week).
Most
who snore are healthy. But about 1% snore because of OSAHS, which refers to
breathing that starts and stops during sleep.
When
sleeping, your child’s muscles are more relaxed than when they’re awake. In
some cases, however, the throat and breathing muscles over-relax and interfere
with breathing. In other cases, muscles relax normally, but the throat closes
nonetheless due to enlarged tonsils and adenoids, obesity, nerve and muscle
problems, facial and jaw abnormalities as well as Down’s Syndrome.
There
are two categories of snoring: Primary snoring and snoring that indicates
OSAHS.
“It
is difficult to tell the two apart,” says Dr Jenny Tang, who is also KKH’s
director of Sleep Disorders Programme.
“Primary
snoring is normal but may infrequently progress to OSAHS in the presence of
risk factors like obesity and neuromuscular problems.”
KKH
sees an average of 25 new cases monthly, with ages ranging from 3 to 18, for
possible sleep apnea. It is most common in children between three to seven, and
in obese adolescents, she adds.
Although
nasal and respiratory allergies and infections can worsen existing OSAHS, they
are unlikely to be the primary causes. Left undiagnosed, OSAHS can lead to
heart failure, delayed growth and even death due to prolonged oxygen
deprivation.
Detect
and treat
OSAHS
can be diagnosed through a polysomnography test, conducted in a laboratory by a
sleep specialist.
Small
recording devices are placed on the child’s head and body to monitor sleeping
and breathing patterns, muscle activity, limb movements, brain waves, and heart
rate. The devices pose no danger or pain. It can determine the magnitude of the
problem and also allow the specialist to decide on the best treatment.
Treatment
depends on underlying causes, Dr Tang advises. Doctors may recommend surgery to
remove enlarged tonsils and adenoids, or correct jaw and facial structural
problems.
When
surgery is unsuccessful or not advised, continued Positive Airway Pressure
(PAP) may be needed. PAP is a small mask worn over the nose when sleeping,
providing air pressure to keep the throat open.
Treatment
for obesity is also essential if it causes OSAHS.
So
the next time you hear your child snore, monitor him for symptoms indicative of
OSAHS. If you suspect OSAHS is the problem, consult a paediatric sleep
specialist immediately
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Obstructive
Sleep Apnea Hypoventilation Syndrome:
The
symptoms
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Unusual sleeping positions (e.g. sleep sitting up or propped up with pillows).
•
Loud and habitual snoring.
•
Restless sleep.
•
Breathing difficulties during sleep, like snorts and gasps. May wake
completely.
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Sweat heavily during sleep.
•
Difficulty in waking up despite adequate sleep.
•
Headaches in the day, especially morning.
•
Irritable and aggressive.
•
Fall asleep or daydream.
•
Behavioural problems.
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