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Dr. Keith Wainscott practices with Dr. Karl Studtmann at the West Tennessee ENT Clinic, 619
Skyline Drive.
For an appointment, call 731-423-2714.
Symptoms of obstructive sleep apnea …
• Snoring: The child has loud snoring or noisy breathing during sleep.
• Periods of not breathing: Although the chest wall is moving, no air or oxygen is moving through the nose or mouth into the lungs. The duration of these periods varies and is measured in seconds.
• Mouth breathing: The passage to the nose may be completely blocked by enlarged tonsils and adenoids leading to the child only being able to breathe through his or her mouth.
• Restlessness during sleep: Frequent arousals lead to restless sleep or “tossing and turning” throughout the night.
• Sleeping in odd positions: The child may arch his neck backwards or sleep sitting up to open the airway.
• Behavior problems or sleepiness: This may include irritability, crankiness, frustration, hyperactivity, and difficulty paying attention.
• School problems. Children may do poorly in school.
• Bed wetting.
• Frequent infections. This may include a history of chronic problems with tonsils, adenoids, and/or ear infections.
Source: Children’s Hospital of Philadelphia
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| Dr. Keith Wainscott evaluates Conlee Benson for enlarged tonsils and adenoids that may be effecting her sleep patterns. |
Although it is perfectly normal to experience an occasional pause in breathing, apnea causes that pause to be 20 seconds or longer, it decreases oxygen levels in the body and disrupts sleep patterns, says Dr. Keith Wainscott, an ear, nose and throat specialist with West Tennessee ENT Clinic.
As many as one to three percent of otherwise healthy preschool-age kids have the most common form of apnea, obstructive apnea, Dr. Wainscott says. As its name indicates, it is caused by an obstruction of the airway, usually due to enlarged tonsils and adenoids. This is most likely to happen while the child is asleep because that is when the soft tissue at the back of the throat is most relaxed.
“It is like breathing through a small, flimsy straw that collapses and blocks airflow,” says Dr. Wainscott. “Many of the short pauses that really only last a few seconds, can wake the child up a bit, increasing muscle tone and opening the airway to allow the child to resume breathing. Many times the child never fully wakes up during these episodes, but just goes into a lighter sleep. When they wake up in the morning, they feel tired, like they have been fighting for their breath.”
Obesity affects sleep apnea
Besides enlarged tonsils and adenoids, “sleep apnea also is on the rise in children because of obesity, which can lead to diabetes,” says Dr. Wainscott. “It is so important for parents to keep theirkids active. Sitting in front of a TV and playing video games is leading to the rise in adolescent obesity, which can lead to lots of other problems.”
The most common symptom of obstructive apnea is snoring followed by pauses or gasping. Other signs of apnea include labored breathing while sleeping; restless sleep and sleeping in unusual positions; or even changes in color. Obstructive sleep apnea can disrupt sleep patterns, causing children to show continued sleepiness after awakening in the morning and tiredness and attention problems throughout the day.
“Studies have shown that with sleep apnea the brain is not fully rested as sleep apnea disrupts normal sleep patterns,” says Dr. Wainscott. “During a sleep apnea episode, oxygen levels in the blood may drop and children may wake up frequently. That is why children with it feel groggy, tired or ill throughout the day. It can even make it harder for them to concentrate and may even compound issues such as ADHD.”
Tonsils and adenoids
Enlarged tonsils and adenoids in children can be caused by infections or they may be normal for that child. “For some children, that is just the way God made them,” says Wainscott. “Sometimes the tonsils and adenoids will shrink or the children’s bodies will catch up to them. Not all enlarged tonsils are infected though.”
Tonsils and adenoids are collections of lymphoid tissue that help the body to fight infection. They trap bacteria and viruses entering through the throat and produce antibodies. The tonsils are located on both sides of the back of the throat and are visible through the mouth. The adenoids are located higher and further back, where the nasal passages connect the throat and are not visible.
When enlarged, tonsils can sometimes interfere with breathing and swallowing and adenoids may block the nose. Most of the time enlarged tonsils and adenoids cause no symptoms. Enlarged adenoids can give the voice a pinched nose quality. Enlarged tonsils and adenoids are considered a problem when they cause a more serious problem, such as obstructive sleep apnea, chronic ear infections and hearing loss; recurring sinus infections and nosebleeds; and weight loss or lack of weight gain.
Enlarged tonsils and adenoids are treated with antibiotics when they are caused by infections. When antibiotics are ineffective, surgery may be recommended to remove the tonsils and adenoids. Removing enlarged tonsils and adenoids is useful only when enlargement causes breathing problems or recurrent infections.
“If you think your child may have sleep apnea. the best way to be sure is to go into your child’s room after he or she has gone to sleep,” says Dr. Wainscott. “If your child is snoring or making noise followed by no sound, that may be a good indication of sleep apnea. If this is happening only infrequently or when the child is sick, it is not an issue of sleep apnea.”
If you suspect your child has obstructive sleep apnea, you should consult your pediatrician, who will determine if a specialist such as an ear, nose, and throat (ENT) physician or an otolaryngologist should see the child.
The treatment of obstructive sleep apnea is based on its cause. Since enlarged tonsils and adenoids are the most common cause, surgical removal of the tonsils and adenoids is usually recommended. An ear, nose, and throat specialist will evaluate the child to see if he or she is an appropriate candidate for surgery.
“As with any surgery, there are risks associated with taking out tonsils and adenoids,” says Dr. Wainscott. “We do not want to do it unless it is absolutely necessary.”