Posted tagged ‘sleep apnea’

Snoring isn’t good for children

October 1, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

In children, snoring may be more of a problem than we thought.

A September, 2012 prospective study of 249 preschool children looked at parent-reported rates of persistent, loud snoring. About 10% of the 2-3 year old children in this sample had persistent, loud snoring—and these kids were much more likely to have significant behavior problems including hyperactivity, inattention, and symptoms of depression. Higher rates of snoring were found in homes with smokers, households with lower socioeconomic status, and among children who weren’t breast-fed—but even after controlling for these factors, snoring itself seemed to be associated with these behavior problems.

Previous studies have already documented that snoring is associated with poor school performance in older children, as well as decreased attention in adults. We also know that in its more severe form, snoring is associated with sleep apnea, which can cause heart and lung problems in adults if untreated.

Parents can look out for these signs of possible sleep apnea in their children:

  • Frequent snoring (> 2 – 3 times per week)
  • Labored breathing during sleep
  • Gasps/snorting during sleep
  • Prolonged bedwetting
  • Sleeping in a sitting position
  • Sleeping with the neck hyperextended (in a “looking up” position)
  • Headaches upon awakening
  • Daytime sleepiness
  • Attention-deficit disorder or learning problems

In addition, the physical examination of children with sleep apnea can include overweight or underweight, big tonsils, poor growth, and high blood pressure. However, even without any of these findings, this recent study suggests that persistent loud snoring alone may have important consequences.

If your child is a loud snorer, look for the symptoms above and talk with the pediatrician. To know for sure if there are problems with breathing during sleep, a sleep study may be needed. Alternatively, some pediatricians may prefer to refer to a specialist like an ENT (ear-nose-throat) doctor for further evaluation.

Treatment can include a trial of medications. Though none are specifically FDA approved to treat snoring or sleep apnea, there is good evidence that inhaled nasal steroids may help, and a very recent study showed that a common asthma/allergy medicine called montelukast may also be worth a try. If medicines don’t work, or if symptoms are quite significant, the most definitive treatment is surgical removal of the tonsils and/or adenoids.

Snoring isn’t just a problem for Wilma Flintstone. If your child has significant, loud, persistent snoring it might be causing some real problems. Go get it checked out.

“What the heck are adenoids, and why does the doctor want to remove them?”

June 15, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Let’s get this one thing straight first: you’ve only got one adenoid. I don’t know why it’s referred to in plural, but let’s put a stop to that right now. Just one. Adenoid.

Your adenoid is a blobby sort of tissue, way back behind your nose. Want to touch it? Just stick your finger waaaaaaay up your nose, back about as far as you’d have to reach to touch the back of your throat. Go ahead, try. (Better yet, don’t. I was kidding. Do not sue the nice doctor.) I’ll bet you never even thought your nasal cavity went back that far. Kind of cool. All the way back there, hanging off the back wall of your nasal cavity, sort of right in the middle of your head, is a little fleshy blob, the adenoid. It can’t be seen directly, but an ENT (ear, nose, and throat) specialist can snake a little scope up the nose to get a peek, or get an indirect view with an x-ray.

What’s it for? It’s made of the same kind of tissue as tonsils, so it presumably has something to do with the immune system. Like tonsils, it probably does its job very early in life, or even before birth. Removal of either tonsils or the adenoid in children does not seem to lead to any increased risk of infection—so basically, at least once your children are a year or so old, the adenoid doesn’t seem to do anything useful at all.

In fact, sometimes the dang thing just kind of gets in the way. The most common reason for removal of the adenoid is that it gets too big in some children, and dangles into the back of the nose. This makes it hard to breathe. During the day, kids with a huge adenoid often breathe through their mouths. It gets worse at night—when the muscles of the face and mouth relax, that big honking adenoid can drop down and cause loud snoring, interrupted breathing, and sleep apnea. This leads to fragmented, poor quality sleep, and sometimes grumpy kids and parents. Worse, chronic poor sleep can affect school performance, and can eventually cause permanent damage to the lungs and heart. Bad news. If your child has symptoms of trouble breathing at night or loud snoring (the kind you can hear from another room), you need to talk with the pediatrician about a referral for evaluation of both tonsils and the adenoid.

Another common reason to consider removal of the adenoid is to prevent ear infections. The adenoid is located right near the auditory (or “Eustacian”) tube, a connection to the middle ear. Some kids with recurrent ear infections are being re-infected by bacteria that hide on the knobby surface of the adenoid. The large adenoid may also at times physically clog up that auditory tube, preventing drainage of mucus from the middle ear—and that further increases the risk of infection. Removal of the adenoid does lead to fewer ear infections, and should be considered especially in children who’ve already tried more-conservative measures.

A little more controversial is the role of the adenoids in recurring sinus infections. Again, the knobby tissue itself may be chronically infected, which might serve as a “hiding place” for bacteria, allowing them to sneak back into the sinuses even after an infection is successfully treated. There’s also some evidence that chronic inflammation of the adenoid might lead to swelling and inflammation of the sinuses, which prevents good drainage and further contributes to infection. Studies of the effect of removing adenoids from children with recurrent sinusitis haven’t been super-impressive, but the procedure does seem to help at least some children. Recurring sinusitis can be a complex problem, and I don’t think there is a one-size-fits-all approach. Adenoid evaluation and removal is probably a good option in some cases.

If surgical removal is needed, it’s a pretty straightforward procedure with a short recovery in children. Sometimes removal of the adenoids is combined with tonsillectomy and maybe ear tubes as well, sort of an ENT trifecta. Work with your ENT to decide on the best approach to your child’s situation, and feel free to ask for a discount—especially if you already took the trouble to reach back there yourself. I said I was kidding!

Thanks to ace ENT Julie Zweig, MD of Northeast Atlanta ENT in Johns Creek and Lawrenceville for her help reviewing this article.

 

EDIT (12/16/2013): When reviewing this article, I don’t think I did a good job explaining that there are risks to adenoid surgery (as with any surgery.) Though the procedure is, as I said, “pretty straightforward with a short recovery”, there is a small but real risk of complications. The rate of complications is much higher when adenoidectomy is combined with removal of the tonsils.