boy sleeping

Many children experience sleep disorders. These range from night terrors and sleep walking to serious breathing disorders during sleep. A few of the breathing disorders known to affect children and their sleep are listed here.

At the University of Maryland Children's Hospital, our pediatric sleep disorder clinic treats these and other sleep issues in children.

Obstructive Sleep Apnea (OSA) in Children

One of the most common abnormalities of breathing during sleep with children is obstructive sleep apnea. OSA occurs in approximately 2 percent of all children, and is most common in preschool-age children.

Symptoms of OSA

  • Snoring
  • Restless sleep
  • Interruption of breathing (apnea)
  • Chronic mouth breathing
  • Difficulty awakening
  • Bedwetting
  • Problems with school performance

Risk Factors

  • Large tonsils and/or adenoids
  • Obesity
  • Abnormalities of the head and neck

The diagnosis of OSA cannot be made by asking questions about the child's sleeping pattern alone, but must be made by evaluating the child during sleep in a sleep laboratory (polysomnography). In addition, the sleep study is useful for identifying children of high risk of complications from anesthesia and surgery. Untreated OSA can lead to heart failure, poor school performance, and high blood count.

Treatment of OSA

The treatment of OSA depends on its severity and includes:

  • Surgery if tonsils and/or adenoids are enlarged
  • Weight reduction if the child is obese
  • Non-invasive nasal pressure support (BiPap)
  • Tracheostomy when severe

Central Hypoventilation Syndrome (CHS)

CHS is a problem of the central nervous system's signals to breathe. This disorder is frequently worse during sleep and is characterized by slow and/or shallow breathing inadequate for removing carbon dioxide from the lungs. CHS may occur at birth (congenital) or as a result of pressure on the brainstem (trauma, tumor, brain damage). Diagnosis can be made by overnight sleep study. Treatment may require relief of brainstem pressure depending on the cause, or chronic support with a ventilator.

Central Apnea of Prematurity

Central apnea of prematurity is common in newborns and is more likely the more premature the newborn. It may be associated with color changes (blue around the lips or face) and low heart rate (bradycardia) and is due to an immaturity of the central respiratory drive. Apnea of prematurity can be diagnosed by daytime sleep study or by cardiorespiratory monitoring. Treatment consists of caffeine and or oxygen and typically resolves over the first few months of life.

Chronic Lung Disease

Chronic lung disease is frequently a result of premature birth, but may be secondary to lung injury after the neonatal period as in aspiration syndromes, sickle cell disease, and neuromuscular diseases such as certain types of muscular dystrophy.

Chronic lung disease is characterized by low blood oxygen and high blood carbon dioxide levels. Evaluation is possible by day (age < 6 months) or overnight (age > 6 months) sleep study and can determine when the lung disease is resolving or progressing. Therapy consists of oxygen, non-invasive ventilatory support (nasal BiPap), or when severe may require tracheostomy with ventilator support.