This group of children is the where we can most easily address the causes of OSA. The permanent teeth begin to come in and the children start to grow, speak well, read and write. They also tend to sit (usually in a contorted positioning) for long periods of time. They sleep a lot (growth hormone is released primarily during sleep). And they develop allergies to anything and everything. Allergies account for most of the cases of OSA in this group as allergies cause blockage of the upper airway (see the page on UARS) as well as hypertrophy or overgrowth of the tonsils and adenoids. Obesity in this group can result in OSA and with the inactive young generation we have, is a serious concern. 25% of this age group are suspected of having OSA! Congenital facial deformities such as a small mandible or deep overbite cause the tongue to be positioned too far back increasing the risk of an airway blockage problem.
The symptoms of OSA in this group of children is similar to younger children with some additional results:
Night time symptoms:
- breathing through the mouth
- sleep talking
- sleep walking
- bruxism (tooth grinding)
Day time symptoms:
- learning and behavioral problems
- may present as hyperactive and inattentive similar to ADHD (40% of ADHD patients actually have sleep apnea!)
- lack of energy, often labeled as “lazy”
- failure to thrive, underweight and undersized compared to siblings
- poor school performance
- poor attention
- impaired memory
- poor coordination, clumsy, avoidance of sports
- often present as hyperactive very similar to ADHD, have difficulty completing tasks
Diagnosis in this group may be a sibling sleeping in the same room observing a long interruption in breathing or hear gasping or choking sounds if sleeping in the same room, or direct observation by a parent of the same symptoms. The definitive diagnosis is made by an overnight sleep study where the child is monitored during the night and signs if apnea events a hypoxic (low oxygen levels) are recorded. Some polysomnogram recorders record jaw muscle contraction and record sleep-related bruxism as well. There are sleep labs specifically for children that can assist in diagnosis.
Treatment is often removal of residual or re-grown tonsils and adenoids, Phase 1 orthodontics consisting of widening of the palate to open up tongue space (expansion appliances, ALF appliances, Craniosacral treatments etc.). This treatment can be initiated in children who have all of their 1st permanent molars fully erupted as well as all 8 permanent incisors fully erupted. The average age for this is 8 to 8 1/2. Treatment takes between 9 and 12 months and can significantly improve the oral functions of the child (better eating leading to improved nutrition, improved swallowing by giving the tongue more space etc.) and can significantly reduce the need for extensive braces later in. Twin Block dual arch appliances can advance the lower jaw in a child if it is receded or pushed back. This appliance works well in correcting deep overbites and can help OSA symptoms in this age group. The treatment takes about 12 months. There are hundreds of Phase 1 orthodontic appliances available, each with its own merits. Please talk to your child’s dentist or child’s orthodontist/pedodontist for more information on what might work best for your child.
Considering the significant effect that sleep apnea has on a child’s school performance, learning, memory and ability to participate in sports, every child with suspected sleep apnea should be investigated. The additive affects of sleep apnea can change the course of a child’s life with poor grades (preventing them from getting into college or university) and missed opportunities to build a healthy strong body during the growing years.