During normal breathing, air passes through the throat on its way to the lungs. The air travels past the soft palate, uvula, tonsils, and tongue. When a person is awake, the muscles in the back of the throat tighten to hold these structures in place preventing them from collapsing into the airway. During sleep, these structures can fall into the airway causing snoring and obstructive sleep apnea.
Sleep apnea is characterized by loud snroing and distrubed or interruped sleep patterns. Sleep apnea can have serious consequences including cardiac problems. Frequently patients will awaken in the morning with a headache. If they become sleep deprived they may feel sleeppy all day, and may fall asleep while driving in the car.
Sleep apnea is diagnosed by a sleep study. During a sleep study, the patient's breathing patterns, heart rhythim and brain waves are monitored.
If it is found that sleep apnea is present, most doctors recommend the use of CPAP. CPAP is a breathing device worn during sleep to help keep the airway open. In some situations surgery is recommended. The uvulopalatopharyngoplasty with or without tonsillectomy are surgical procedurs designed to open the airway. In rare situations, a tracheostomy is necessary. These are procedures designed to circumvent this sleep related collapse of these structures.
Obstructive sleep apnea & tonsils
Obstructive sleep apnea in normal children is almost always caused by enlarged (hypertrophic) tonsils and adenoids). These children will display the typical sleeping patterns of sleep apnea. They have loud snoring, frequent pauses with breathing at night, frequent awakening from sleep, restless sleep, nightmares, and bedwetting (enuresis). During the daytime, these children are mouth breathers, may have excessive daytime sleepiness, and poor school performance.
Other more rare causes of sleep apnea include any congenital (present from birth) or acquired cause of upper airway obstruction.
The treatment of obstructive sleep apnea is directed to the cause of the obstruction.
As noted above, most cases of obstructive sleep apnea in children is caused by enlarged tonsils and adenoids. Surgical interventions are therefore directed to what is causing the obstruction. In the case of enlarged tonsils and adenoids, tonsillectomy and adenoidectomy is usually successful in relieving the problem. If the problem is not the tonsils and adenoids, the cause of the obstruction must be determined. For example, surgery of the jaw may be required. In some cases, even a tracheostomy is necessary. Non-surgical therapies include oral prostheses (difficult in children), medications (steroids, stimulants), and weight reduction.
In almost every case of obstructive sleep apnea in children who do not have unusual anatomic problems, tonsillectomy and adenoidectomy is a safe and effective treatment, and is highly recommended.
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