Diagnosing Sleep Apnea in Children

Experts at Hassenfeld Children’s Hospital at NYU Langone employ a variety of resources to diagnose sleep apnea in infants and children. Sleep apnea is a chronic condition in which breathing pauses from time to time during sleep as a result of a partial or complete blockage in the airway. These pauses can last for a few seconds or longer, interrupting normal breathing and sleep patterns.

Sleep apnea can occur at any point during childhood, from infancy through adolescence. It is most common in young children who have tonsillitis or adenoiditis—enlargement of infection-fighting tissues in the back of the nasal cavity and throat—caused by infections or allergies.

When swollen, tonsils and adenoid tissue can block a child’s small airways. Being overweight also increases the risk of sleep apnea in children, because extra tissue in the airway can block air flow.

Children with unusual facial anatomy, such as small nostrils, a cleft lip or palate, a small jaw, or choanal atresia—in which the cartilage that separates the nasal passages doesn’t form properly during the baby’s development—may have difficulty breathing through one or both nostrils. In most instances, choanal atresia causes a blockage in only one nostril. However, in infants with a blockage in both nasal passages, the condition can be life threatening.

Certain genetic syndromes put children at increased risk for sleep apnea. For instance, children with Down syndrome may have an enlarged tongue, a flattened bridge of the nose, or a narrow airway or jaw, all of which can contribute to sleep apnea. Other genetic syndromes that affect the development of the face and lead to sleep apnea include Pierre Robin syndrome (or sequence), Treacher Collins syndrome, and Nager syndrome.

Neuromuscular disorders, such as cerebral palsy or muscular dystrophy, allow the tongue to fall back into the throat, blocking the airway.

Although rare, unusual growths in the airway, such as tumors and cysts, can also cause sleep apnea in children.

Signs and Symptoms

Symptoms of sleep apnea vary from child to child. Loud snoring, which may be followed by pauses in breathing or gasping for air, is the most common symptom. Snoring occurs when extra tissue in the palate or the uvula—the soft, fleshy lobe of tissue that hangs from the back of the roof of the mouth—vibrates during breathing.

Some children with sleep apnea don’t snore but have noisy, labored breathing during sleep. Others breathe through their mouths, even during the daytime. Infants with choanal atresia in one of the nasal passages may appear to be congested in the affected side of the nose and may have difficulty feeding.

Other signs of sleep apnea in children include excessive sleepiness during the daytime and difficulty waking up. Disturbances in a child’s sleep–wake cycle can also cause frequent awakenings to use the bathroom, bed-wetting, or episodes of sleepwalking. Some children have behavioral problems, which are often mistakenly attributed to conditions such as attention deficit hyperactivity disorder.

In infants, severe sleep apnea can cause feeding difficulties, growth problems, and developmental delays. Over time, frequent sleep disruptions caused by sleep apnea can affect your child’s performance at school.

Our sleep medicine specialists, plastic surgeons, and otolaryngologists may use the results of a physical exam, sleep study, and visual examination of your child’s airway to diagnose sleep apnea and recommend the most effective treatment.

Physical Exam

During a physical exam, your doctor may ask you to describe any noticeable signs and symptoms, such as snoring, restlessness during sleep, bed-wetting, or behavioral problems.

Your child’s height and weight are measured to determine whether he or she is overweight or obese. The doctor also assesses your child’s facial structure for unusual features, such as a small jaw or flat bridge of the nose.

A visual examination of the nasal passages, performed with a special light, can reveal swelling or polyps, which may be caused by allergies. The doctor may also visually examine the throat to determine whether the tonsils are swollen.

In addition, the doctor observes your child’s speech to see whether he or she speaks in a nasal tone or breathes through the mouth.

Sleep Study

Your doctor may recommend an overnight sleep study, or polysomnogram, at NYU Langone’s sleep lab to confirm a diagnosis of sleep apnea.

A sleep study is often recommended for children who have Down syndrome or other genetic conditions that are commonly associated with sleep apnea. Sleep studies are also helpful in diagnosing sleep apnea in children who have symptoms that do not have an obvious cause, such as enlarged tonsils or adenoid tissue.

During the study, specialists use tape or other adhesives to attach sensors to your child’s head, face, legs, and body. These allow technicians to monitor your child’s brain waves, leg movements, eye movements, snoring, and oxygen and carbon dioxide levels during sleep. Attaching the sensors is a painless process and is usually done about an hour before your child’s regular bedtime.

To help your child feel comfortable falling asleep in the sleep lab, our doctors may encourage you or another family member to stay with your child in a separate bed or on a couch.

After your child falls asleep, the sensors provide information about sleeping patterns and the quality of your child’s sleep. They can also detect breathing problems. An audio and video recording is made while your child sleeps that reveals snoring, uncontrolled body movements, or sleepwalking.

Results of the sleep study are interpreted by experienced specialists at the Pediatric Sleep Disorders Program at Hassenfeld Children’s Hospital. Doctors determine the severity of your child’s sleep apnea based on the average number of breathing disturbances per hour of sleep.

If the study confirms that your child has sleep apnea, the sleep specialist may refer you and your child to an otolaryngologist to evaluate the possible cause.

Nasal Endoscopy

If your doctor suspects that your child has adenoiditis, or swollen adenoid tissue, an otolaryngologist at Hassenfeld Children’s Hospital may perform a nasal endoscopy. This diagnostic method enables the doctor to obtain a clear picture of your child’s adenoid tissue, which cannot be seen as easily as the tonsils.

This test is performed in less than five minutes in the doctor’s office. First, the doctor sprays your child’s nose with a local anesthetic to eliminate discomfort. Then the doctor inserts an endoscope—a narrow, flexible tube with a fiberoptic light and a camera attached—into the back of your child’s nose to look for signs of inflammation.

Imaging Tests

Occasionally, doctors may notice unusual anatomic features during a prenatal ultrasound that can cause sleep apnea in a baby. Physicians may pay particular attention to the structure of the face if other prenatal tests, such as amniocentesis or chorionic villus sampling, have detected a genetic condition such as Down syndrome, which is associated with unusual facial development.

If a baby is born with a small airway, jaw, or nostrils, a doctor typically requests imaging tests, such as X-rays, CT scans, or MRI scans. X-rays and CT scans are used to examine bones, such as the jaw. MRI scans can provide a picture of soft structures in the airway, such as growths, that might be a cause of sleep apnea.

Our craniofacial surgeons—doctors who specialize in treating problems with the structure of the skull, face, neck, and jaws—review these imaging studies to help determine the most appropriate treatment for your child.