Obstructive sleep apnoea is a condition that affects the airway and how we breathe.
Usually, each time we breathe in, air passes through the nose, where it is filtered, warmed and moistened. It then travels down the upper airway to the lungs. The oxygen contained in the air is absorbed into the bloodstream in the lungs and is transported to where it is needed in the body.
When we are asleep, the muscles in the body naturally relax and become floppy. In some people this can cause the upper airway to fall in on itself, making breathing difficult. This can lead to bigger and bigger efforts to breathe, which can narrow the airway further. At this stage, the body senses the airway problem and the person wakes up briefly.
This returns the airway to normal again, allowing them to breathe, and the person goes back to sleep. This process of periods of struggling to breathe, followed by waking briefly, may happen many times during the night.
Generally the person recalls very few, if any, of these events in the morning. This condition is called obstructive sleep apnoea.
How common is it and whom does it affect?
Obstructive sleep apnoea is common in both adults and children. People with some conditions (obesity, sickle cell disease, Down syndrome and others) may have a higher likelihood of obstructive sleep apnoea, but exact figures are not known.
What are the symptoms of obstructive sleep apnoea?
The first symptom most parents notice is snoring. Snoring is the sound made by the airway vibrating as it opens after it has partially collapsed. Parents may also notice children sleeping in unusual body positions that make it easier for them to breathe.
Recurrent breathing problems may cause frequent, brief arousals throughout the night. These sleep disturbances can make the child sleepy during the day.
Younger children who suffer from sleep deprivation may actually be hyperactive or aggressive, whereas older children may feel tired.
A child with sleep apnoea may have difficulty concentrating or behave differently. They may awake from sleep feeling tired and unhappy, with a headache, or may refuse breakfast. Poor growth and weight gain are additional symptoms.
How is it diagnosed?
The child will have a sleep study performed. This is a test performed during an overnight visit to hospital, which measured various body functions, such as breathing pattern and heart rate. This determines the child’s sleep quality and breathing pattern.
From the results of the sleep study, the medical professionals associated with the child’s care will make a diagnosis of obstructive sleep apnoea.
What causes obstructive sleep apnoea?
Sleep apnoea can occur for many reasons, both in adults and in children. In children, the most common cause is enlarged tonsils and/or adenoids, which can partially block the airway.
Sleep apnoea affects the quality of sleep in both children and adults. It influences how the child feels during the day, and most importantly, it can be treated.
What treatments are available?
Options for treating obstructive sleep apnoea include:
- An Ear, Nose and Throat (ENT) review – a child may have an appointment with an ENT surgeon to see if there are any problems with the airway that can be corrected with an operation.
- Nasal prongs – this is a soft plastic tube with two prongs that are inserted into the child’s nostrils. These help the child’s breathing at night by keeping the airway open.
Another option for treating obstructive sleep apnoea is CPAP.
What is CPAP?
CPAP means ‘Continuous Positive Airway Pressure’ which means that a continuous flow of air is given to the child via a mask, which helps to maintain their airway and aids in breathing at night. When used correctly every night, the child’s sleep quality and daytime symptoms should improve.
What do I tell my child about CPAP?
Parents can explain to their child that they are using their machine to help them to breathe at night so that they will feel better during the day. The child must get into a routine of using their equipment all night, every night and be encouraged by those around them.
Support from parents and carers is central to the success of this treatment. At first, CPAP can be frightening for children but hopefully they will have had a positive experience in hospital and feel confident about using it at home.
Different approaches may be required for children of various age groups:
- Babies will not understand what CPAP is, so parents should simply place the mask on their child at bedtime.
- Infants will probably be more difficult and refuse to wear their mask or be frightened by it. If they are frightened when the pressure starts, parents can help by letting them fall asleep with the mask on and starting the pressure when they are asleep.
- CPAP can be explained to older children, and it is important that those around them are helpful and encouraging.
- Teenagers may become ‘fed up’ at times with their treatment. They may be embarrassed at having to use their equipment when staying over with friends. Depending on medical advice, the child may be allowed to have an occasional night off their treatment.
Ensuring a good mask fit and preventing mouth leaks can resolve many problems.
Parents must not change anything about their child’s treatment unless they have spoken to the medical professionals associated with the child’s care.
Where do I get a CPAP machine and supplies?
Arrangements will be made between Great Ormond Street Hospital and the parents local Primary Care Trust (PCT) to provide the child with a suitable CPAP machine if required. Once treatment levels are established, the local PCT will be responsible for replacing broken equipment and consumables.
What if the CPAP machine or supplies break or malfunction?
Most children will not suffer from one night without CPAP treatment. However, some children with rare conditions need CPAP every night. The doctor will tell parents if this is the case with their child.
If a problem occurs outside of office hours parents can call on the following morning to alert the medical team to the problem. They will work with the parents and the local health agency to service the machine or replace supplies as soon as possible.
If parents notice something out of order during office hours, they are requested to contact the team immediately. It is possible that the problem can be solved before bedtime.
How do I look after the CPAP equipment?
Please do not play with the buttons or settings on the machine. A qualified sleep technologist will make any necessary adjustments. Parents should bring the machine to be serviced when they attend for future sleep studies. To clean, wipe with a clean damp cloth.
The air filter should be replaced approximately every six months, and more frequently if needed.
Do not wash and/or recycle used air filters.
CPAP mask, headgear and tubing
The mask and tubing should be disconnected and aired out daily.
They should also be washed regularly (once a week or more frequently if necessary). To do this parents will need to take the mask apart, separating the headgear parts, mask frame and soft cushion; fold over the Velcro® ends on the headgear so that they do not become frayed.
Parents may hand-wash these in warm soapy water, making sure that the tubing is completely under the water. When finished, rinse all the parts well and allow to dry in the air, away from direct sunlight.
The child will need follow-up appointments and studies to see how treatment is progressing. When they come for a follow-up appointment and study, parents should bring all of the child’s equipment, including mask, machine, tubing, leads and so on, so that they can be checked and cleaned.
We will be able to decide whether any equipment needs replacing and also whether it is being used properly.
What is the outlook for children with obstructive sleep apnoea?
If the child follows the treatment plan, there will be an improvement in the quality of their sleep. The benefits associated with this are likely to be reduced tiredness during the day, better school performance and further growth and development.