Obstructive sleep apnoea

OSA is a condition that affects the airway and how we breathe. It is named ‘OSA’ because:

• Obstructive- there is obstruction of the airway in the nose, throat or upper airway.
• Sleep- it occurs during sleep.
• Apnoea- this means ‘cessation of breathing’- there is not enough air entering the lungs.

While breathing, air travels from the nose along the upper airway to the lungs. The oxygen in the air then passes into the bloodstream and is transported around the body.

While asleep, muscles in the body naturally relax, including those in the throat. The relaxed muscles allow airway narrowing, which can reduce the flow of air and make breathing difficult, particularly in those who have large tonsils or adenoids (lumps of tissue at the back of the throat). This can cause snoring and disturb breathing.

If breathing is interrupted or reduced, there may be a fall in the body’s oxygen level. This may lead to bigger efforts to breathe. The brain tells the body to restart or increase breathing and this can cause a brief waking. Breathing often restarts with a gasp or snort which returns the airway and breathing to normal, and a return to sleep. This cycle can occur frequently over the night and disturbs the quality of sleep.

People with OSA usually don’t remember most of these awake episodes in the morning

OSA can occur in adults and children. The most common cause in children is enlarged tonsils or adenoids, which can partially block the airway. OSA is reported in one to three percent of children and is more common in children with specific conditions including obesity, sickle cell disease, Down’s syndrome and others.

You may notice your child:

• Snoring.
• Sleeping in an unusual position (which may help them breathe more easily).
• Briefly waking throughout the night.
• Feels sleepy or has difficulty concentrating throughout the day. This may affect school performance.
• Wakes up feeling tired and unhappy or refuses breakfast.
• Has poor growth and weight gain.
• Younger children may become hyperactive or aggressive.

An overnight sleep study is the main method of investigating OSA and is best conducted by clinical physiologists experienced in working with children.

In a sleep study, we record measurements such as breathing, heart rate and oxygen levels while your child sleeps. We also take a video and sound recording. A paediatric sleep medicine physician will then interpret the results and make a diagnosis of OSA if appropriate.

Once OSA is confirmed, we will discuss the most appropriate treatment options for your child with you.

Surgery

Surgery to remove the adenoids and/or the tonsils is the most common treatment for children with OSA. This procedure can usually be performed at a local hospital.

An alternative to surgery might be Positive Airway Pressure therapy (CPAP or BiPAP).

CPAP or BiPAP

This requires the child to wear a mask, usually over the nose, whilst they sleep. There are many sizes and types of mask and several may be tried in order to find the one most comfortable for your child. A positive pressure is applied from a ventilator to keep the airway open while asleep. The physiologist adjusts the ventilator so that the lowest pressure is used to achieve this.

Other treatments

Other treatments may include:

• Using a nasopharyngeal airway (NPA). This acts as a ‘splint’ to maintain an open airway and keep the tongue from falling back. This treatment is predominantly used in children less than one year of age.
• Nasal steroids or montelukast to clear any inflammation of the nasal passage.
• Orthodontic procedures to move the jaw forward.
• Following a weight management program if your child is overweight or obese. This would include nutritional advice, an exercise plan, and behavioural recommendations (including adequate sleep).

If your child has finished their treatment, or it’s been decided to wait and follow progress, a follow up sleep study or sleep clinic will be arranged. This enables the sleep physician to assess if the treatment has worked or if an alternative therapy is required.

Treatment of OSA in children and young people has been shown to help with learning, behaviour, and quality of life plus has long term neurodevelopmental and cardiovascular benefits.

• Asthma and Lung UK supports anyone affected by a breathing disorder, including obstructive sleep apnoea. You can call their helpline on 0300 222 5800 (Monday to Friday, 9am to 5pm) or visit Asthma and Lung UK
• The Association for Respiratory Technology and Physiology has an information sheet on sleep disorders and tests: ARTP information sheet
• The Sleep Apnoea Trust offers support to anyone affected by OSA. Visit their website at Sleep Apnoea Trust

If you have any questions or concerns and wish to speak to one of the Sleep Physiologists, please contact the Sleep Unit Monday to Friday: 9am – 5pm

Telephone: 020 7405 9200 ext. 0462.