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Sleep Apnea in Young Children Associated with Big Tonsils and Enlarged Adenoid Tissue

Investigators using magnetic resonance imaging (MRI) studied the upper airway of 18 young children with obstructive sleep apnea syndrome (OSAS) and 18 young controls. They found that the children with OSAS had much smaller upper airway volume which was further restricted by significantly larger tonsil and adenoid tissue.

Writing in the second of two August issues of the American Thoracic American Journal of Respiratory and Critical Care Medicine, Raanan Arens, M.D., of the Division of Pulmonary Medicine, Children’s Hospital of Philadelphia, along with 7 associates, compared the upper airway structure of the 18 young children with OSAS (average age 4.8 years) with 18 matched control subjects who had no sleep apnea. They discovered that the upper airway volume of the OSAS patients was significantly smaller in comparison with the controls, and that their adenoid tissue was 55 percent larger and that their tonsils were 58 percent bigger.

The 18 young OSAS patients in this study were diagnosed with a sleep test (polysomnography) which indicated an average of 4.3 apneic events per hour of sleep. The apnea-hypopnea index showed 11.2 events per hour. The matched control subjects demonstrated no sleep apnea.

According to the authors, OSAS strikes 2 percent of young children. Apnea is the arrest or stoppage of respiration during sleep that usually lasts longer than 10 seconds before breathing resumes. Hypopnea is slow, shallow respiration. The peak incidence of OSAS in childhood occurs between the ages of 2 and 6 when lymphoid tissue such as tonsils and adenoids grows rapidly.

The researchers believe that the oversized adenoid tissue and larger tonsils are the main factors contributing to airway restriction in the young OSAS patients. They found no correlation of percent difference in airway volume alone with the severity of OSAS.

Diagnosis and management of OSAS are important because, if left untreated, the problem can lead to altered neurodevelopment, growth retardation, pulmonary hypertension, and an enlarged right ventricle of the heart.

Dr. Arens said: “Magnetic resonance imaging has not been used in the past to systematically evaluate the upper airway of children with OSAS. It provides superior resolution of tissues composing the upper airway, is reproducible, and is free of ionizing radiation.”

The 18 matched controls had normal development and cognitive function, intact tonsils and adenoid tissue, no craniofacial abnormalities, and no respiratory disorders. They received their MRI scans to check for such problems as a single seizure or febrile convulsion, headache, head concussion, eye injury, etc. In the control children, none of the clinical indications could be expected to affect upper airway anatomy.

From http://www.thoracic.org/sections/publications/press-releases/journal/august-2001.html

Sleep is Suspect in Kids Headaches

Sleep is suspect in kids' headaches

By JANET CROMLEY / Los Angeles Times

If your child is dogged by headaches, he or she might also have another problem – frequent sleep disturbances.

Researchers at the Mayo Clinic have found that more than two-thirds of children ages 6 to 17 suffering from chronic headaches also have sleep problems, especially getting to sleep.

Headache expert Dr. Kenneth Mack, a Mayo Clinic pediatric neurologist and lead investigator of the report, initiated the study after observing a sleep-headache link in adult patients.

"If you ask adults what are the biggest triggers for their headaches, they will say 'not getting enough sleep' and 'stress,' " he says. "We thought this would apply to children as well."

The researchers reviewed the charts of 200 children evaluated at the Mayo Clinic between 2001 and 2005. They found that kids with chronic daily headaches (15 or more headache days a month for more than three consecutive months) had a much greater incidence of sleep disturbance than did kids who had less-frequent headaches.

The study didn't examine whether lack of sleep causes headaches or vice versa. But Dr. Mack has generally found that his headache patients get better when the sleep problems are resolved.

Dr. Mack and his co-authors suggest that the possibility of a sleep disturbance needs to be considered in any pediatric patient with headaches.

Both of the symptoms can be tackled. For sleep problems, Dr. Mack sometimes suggests medications such as melatonin. He also recommends lifestyle changes – such as establishing a nightly bedtime routine.

To treat the headaches, Dr. Mack recommends that children stay active, eat regular meals and, in some cases, take antimigraine medications.

About 4 percent of girls and 2 percent of boys suffer from chronic headaches, and 10 percent to 20 percent of children have episodic headaches, which can lead to chronic headaches.

Dr. Frisca Yan-Go, medical director of the Sleep Disorders Center at Santa Monica-UCLA Medical Center, says that although chronic headache sufferers don't always grow out of their condition, they can learn to manage their headaches.

"Once the patient identifies the factors causing his headache, whether it's sleep, stress, school or family problems, he can begin to work on them," she says.

Infant Snoring Tied to Parental Snoring

MONDAY, April 10 (HealthDay News) -- Infant children of parents who are habitual snorers are themselves at increased risk for frequent snoring, a new study reveals.

The study also found that young children diagnosed with atopy -- a tendency to develop allergies and asthma -- are also prone to frequent snoring.

And African-American children are at elevated risk for chronic snoring, the researchers said.

The findings are important, the researchers said, because so-called "sleep-disordered breathing" among children has been previously associated with the development of learning disabilities, heart disease, and metabolic disorders.

"Early intervention can reduce morbidity due to sleep-disordered breathing," said study lead author Dr. Maninder Kalra, an assistant professor of pediatrics at Cincinnati Children's Hospital Medical Center.

Kalra and his colleagues noted that the American Academy of Pediatrics already recommends that all children be screened for obstructive sleep-disordered breathing.

Whether it occurs in children or adults, snoring is tied to the dynamics at the back of the mouth and nose, where airflow can become disrupted, according to the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS). The snoring noise is produced when the throat and tongue vibrate against portions of the roof of the mouth, such as the palate and uvula.

Nasal allergies, infections, structural irregularities and problems related to the tonsils and adenoids -- the infection-fighting spongy tissue above the mouth roof -- are also linked to the onset of snoring.

Surgical, laser and radio-wave treatments for patients of all ages can offer some relief to chronic snorers, by clearing obstructions and tightening loose throat tissue. Nasal masks designed to increase air pressure can also help.

For less-serious adult cases, physicians suggest a range of lifestyle changes, such as adhering to routine sleep patterns, weight loss, sleeping on one's side, and avoiding alcohol and sleeping medications before turning in.

The new infant-risk findings were based on tallies of the incidence of snoring among 681 children living in the Cincinnati area. All the infants were born to parents who were themselves diagnosed as atopic. The average age of the children -- 80 percent of whom were white, and 55 percent of whom were boys -- was just over 1 year.

Habitual snoring was defined as snoring three or more times a week. The parents completed questionnaires to identify any relationship between infant snoring and parental snoring, infant atopic status, and infant exposure to parental smoking.

Blood tests were also done to assess infant allergies, including those related to grass pollens, ragweed, various trees, dust mites, penicillin, cockroaches, cats, and dogs.

Reporting in the April issue of the journal Chest, the study authors noted that among the parents, 20 percent of the mothers and 46 percent of the fathers were found to be habitual snorers. According to the AAOHNS, an estimated 25 percent of adults snore regularly, while 45 percent snore on occasion. The phenomenon commonly affects men more often than women.

Among the children, those infants with at least one parent who was a habitual snorer were almost three times as likely to snore frequently than those with no parental history of snoring.

Children who tested positive for atopy were found to be nearly twice as likely to be habitual snorers as non-atopic children.

African-American children also appeared to have a higher risk for snoring -- they were almost three times as likely to be habitual snorers.

No association was found, however, between infant snoring and exposure to parental smoking.

"We found that frequent snoring at age 1 is as prevalent as that reported in school-age children," Kalra said. "Parents who snore should be aware that their children are at increased risk for frequent snoring."

So are children with a history of allergies, Kalra said, adding that an estimated 40 million children in the western world suffer from allergies.

One expert said the findings should further the study of sleep apnea, where individuals suffer multiple interruptions in breathing during sleep.

"First, it adds to the growing body of literature for the potential genetic factures that may underline sleep apnea," said Mark S. Aloia, an assistant professor in the department of psychiatry and human behavior at Brown Medical School in Providence, R.I. "I can't think of any other studies that have identified a familial pattern as this one does. And it also serves an important role for identifying potential risk factors for a disorder that's often under-diagnosed and under-treated," he added.

A second study in the April issue of Chest found that women with a higher body mass index (BMI, a ratio of weight to height) appear more likely to be habitual snorers.

The Swedish study, which surveyed more than 6,800 women, also found that snoring was most common among women between the ages of 50 and 59.