Sleep Breathing Machine Shows Clear Benefits in Children with Sleep Apnea

Children and adolescents with obstructive sleep apnea had substantial improvements in attention, anxiety and quality of life after treatment with positive airway pressure (PAP)—a nighttime therapy in which a machine delivers a stream of air through a mask into the nose.

“The benefits occurred even when children didn’t fully adhere to the treatment,” said study leader Carole L. Marcus, M.D., a sleep specialist and director of the Sleep Center at The Children’s Hospital of Philadelphia. The Sleep Center follows thousands of children and adolescents with sleep problems.

The study appears online ahead of print in the American Journal of Respiratory and Clinical Care Medicine.

Obstructive sleep apnea syndrome (OSAS) is a condition of interrupted breathing caused by a narrowing in the throat or upper airway, related to large tonsils and adenoids, obesity or other medical problems. Using continuous positive airway pressure commonly relieves OSAS in adults, in whom it has been studied extensively. However, there have been few studies of PAP in children with OSAS.

“The vast majority of children with OSAS undergo surgery on their tonsils and adenoids instead of receiving PAP therapy,” said Dr. Marcus. “It is difficult to get children to wear the mask used in PAP treatments.” However, surgery is not always effective in treating OSAS in children, especially in obese children,” said Dr. Marcus. She added that many children who require PAP therapy have underlying chronic illnesses such as Down syndrome, or developmental delays. Furthermore, the rising incidence of obesity among children and adolescents has also increased the rate of OSAS in young people.

What happens in people with obstructive sleep apnoea syndrome? When we sleep, the throat muscles relax and become floppy (like other muscles). In most people, this does not affect breathing. If you have OSAS, the throat muscles become so relaxed and floppy during sleep that they cause a narrowing or even a complete blockage of the airway.

When your airway is narrowed and the airflow is restricted, at first this causes snoring. If there is a complete blockage then your breathing actually stops (apnoea) for around 10 seconds. Your blood oxygen level then goes down and this is detected by your brain. Your brain then tells you to wake up and you make an extra effort to breathe. Then, you start to breathe again with a few deep breaths. You will normally go back off to sleep again quickly and will not even be aware that you have woken up.

Sometimes, the airway can just partially collapse and can lead to hypopnoea. Breathing becomes abnormally slow and shallow. If this happens, the amount of oxygen that is taken into your body can be halved. Hypopnoea episodes also usually last for around 10 seconds.

If someone watches you, he or she will notice that you stop breathing for a short time, and then make a loud snore and a snort, perhaps even sound as if you are briefly choking, briefly wake up, and then get straight back off to sleep.