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Sleep Apnea in children leads to serious issues

By April MacIntyre Oct 14, 2010, 0:28 GMT

Sleep Apnea in children leads to serious issues

babies can have a host of problems if premature, sleep apnea issues are one of them EPA/ROLEX DELA PENA

Sleep Apnea is as dangerous in children as it can be for adults.

The result of lack of oxygen can lead to brain cell damage and lowered intelligence according to many studies. At one study at Hopkin's Children's Centre in Baltimore, 31 children between the ages of 6 and 16 (19 of whom had severe sleep apnea) were examined using a special form or magnetic resonance imaging (MRI) and it was found that those children with sleep apnea showed significant changes in both the hippocampus and right frontal cortex - two areas of the brain associated with learning and higher mental function.

This study also found that these children had altered levels of three chemicals within the brain, indicative of brain damage.

The major brain development in children is so rapid in the early years of life that a decrease in oxygen levels will result in a major insult to the brain tissue. Brain images of children with sleep apnea have shown evidence of injury in the parts of the brain responsible for memory, learning and complex thought.

Sleep apnea can also lead to serious, irreversible physical problems. Due to a disturbance in the secretion of growth hormones that occurs during sleep, children with severe sleep apnea may not grow as quickly as they should for their age or exhibit stunted physical growth and not reach their full height. 

According to Joseph A. Broujerdi, MD, DMD, a plastic, maxillofacial and craniofacial surgeon and founder of the Cranio-Maxillofacial Surgery Institute in Beverly Hills, CA., over a prolonged period of time alteration of the growth of the face may lead to Dentofacial Deformity known as Adenoid Face Syndrome. The child will have a long face and an open bite because the teeth do not come together.

The child will be a mouth breather, have an under-developed lower jaw and narrow (high arch palate) over developed upper jaw (gummy smile).

Dr. Broujerdi adds that it is important to emphasize that the signs and symptoms of OSA in children are much more subtle than in adults. 

Many children may only exhibit attention deficit and hyperactive behaviors such as irritability, poor attention span, and lack of concentration leading them to perform poorly in school. Other symptoms in children may consist of restless sleep, sweating during sleep, night terror, sleepwalking, bed-wetting, and daytime fatigue.

Obstructive sleep apnea (OSA) affects 8% or more of children in United States, according to Dr. Broujerdi. He says, "Sleep apnea is almost always an anatomical problem due to partial or total obstruction or blockage of the airway. The obstruction will lead to a disruption of sleep, and snoring is a sign that the disruption is occurring."

Blockage can be caused by enlarged tonsils and adenoids; nasal obstruction (enlarged turbinates); childhood obesity; dentofacial deformity (abnormal jaw growth); or a congenital birth deformity (cleft lip & palate, Pierre Robin Sequence, Hemi Facial Microsomia, Treacher Collins).

Just as in adults, Dr. Broujerdi says that the treatment in children is targeted to the site of obstruction. A new generation of imaging tools used by some doctors allows them to pinpoint the precise problem area (nose, throat, facial bone structure) to assess, plan and simulate the patientís surgery. "The 3D imaging tools can provide a reconstruction of soft and bony tissue formation in approximately 30 seconds, making it ideal for small children," says Dr. Broujerdi.

Since a majority of children with OSA and snoring have enlarged adenoids and tonsils the treatment is adenoidectomy and tonsillectomy (T&A). Surgery is performed under general anesthesia in the hospital. At least one night stay is required. Although the success rate of the surgery is quite high (approximately 80%), some children may still exhibit residual problems. Additional treatment options such as nasal CPAP or orthodontic therapy to widen the jaw should be considered to ensure adequate treatment and avoid developmental delays.

Dr. Broujerdi also noted that children with dentofacial deformity due to OSA will undergo T&A as an initial therapy, if not contraindicates.

Orthodontic evaluation and therapy are important for this group. Patients will generally have rapid palatal expansion during the pre teen years either surgically or orthodontically to widen the upper jaw. Palatial expansion allows for better relationship of the lower jaw to the upper jaw, and increases the dimensions of the airway in the throat for improved air exchange, by stretching and tightening the throat muscles. This will be followed in the late teen years by orthodontic therapy and corrective jaw surgery (orthognathic surgery).

In certain conditions such as very small jaws (micrognathia) children will require early surgical intervention to move the jaws forward with Distraction Osteogenesis (DO) to control retread jaw and tongue position. DO means pulling jaws apart to create new bone. This is performed with a spring device specially made for children. Some of these children may still require additional corrective jaw surgery in the future. Children with congenital birth deformities of the face will require multiple surgical interventions starting early in life and continuing through their teen years.

Dr. Broujerdi tells Monsters and Critics that he recommends that any child with signs of snoring and other symptoms receive a full evaluation, examination and possibly a sleep study.  For more information or to reach Dr. Broujerdi, please visit his website www.cmfsinstitute.com

Joseph A. Broujerdi, MD, DMD is a plastic, maxillofacial and craniofacial surgeon and founder of the Cranio-Maxillofacial Surgery Institute in Beverly Hills, CA.



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