Obstructive sleep apnea is a common but serious condition that inhibits healthy, restful sleep and may lead to learning, behavior and physical health issues in children.
Zarmina Ehsan, MD discusses obstructive sleep apnea in infants and children, why it’s necessary to conduct a sleep study to diagnose the condition and how to treat and manage the condition.
Selected Podcast
Pediatric Sleep Apnea
Featured Speaker:
Learn more about Zarmina Ehsan, MD
Zarmina Ehsan, MD
Zarmina Ehsan, MD, is a pediatric pulmonologist at Children’s Mercy Kansas City and Clinical Assistant Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. She received her medical degree from The Aga Khan University Medical College, Karachi, Pakistan. She completed a residency in pediatrics at Indiana University School of Medicine. Dr. Ehsan has completed fellowships in Pediatric Pulmonology and Pediatric Sleep Medicine at Cincinnati Children’s Hospital Medical Center. Her interests include infant sleep apnea and sleep apnea in children with craniofacial problems and syndromes.Learn more about Zarmina Ehsan, MD
Transcription:
Pediatric Sleep Apnea
Dr. Michael Smith: Our topic today is sleep apnea in children. My guest is Dr. Zarmina Ehsan. Dr. Ehsan is a pediatric pulmonologist who specializes in pediatric sleep medication at Children’s Mercy Kansas City. Welcome to the show.
Dr. Zarmina Ehsan, MD: Thank you so much. Thank you for inviting me to the show.
Dr. Smith: What a wonderful topic. I think a lot of us who practice medicine, and even the late population, I think we know more about the adult side of this problem, but I think we get a little confused about what exactly is sleep apnea in a child. I think this is a great topic. Let's just start with a really nice simple question. What causes sleep apnea in children and is it different from adults?
Dr. Ehsan: You're absolutely right that this is pretty common in adults and we hear about it all the time on the news and on the radio, but pediatric sleep apnea doesn't get as much stress. It’s pretty common so the prevalence is anywhere between 4% to 6% of the population; four to six children out of 100 will have it. It's basically a breathing problem that occurs during sleep. There are two types of sleep apnea. There's the obstructive sleep apnea, or OSA, which is more common and similar to what adults have. There's another type that’s rare that’s called central sleep apnea, or CSA, and the way I like to explain OSA is that there's an obstruction or narrowing in the path from your nose down to the opening of your lungs and this is called the upper airway. From your nose down to right where the lungs open up, that whole path is called the upper airway, and any narrowing there can make it harder to breathe and make it really hard to breathe at night when you're laying down and you're asleep. There can be different reasons for this narrowing or obstruction and we can talk about it a little bit later, but big tonsils, for example, can obstruct that pathway. This all results in less air or oxygen going from the outside into your lungs and results in sleep apnea. The rarer kind of sleep apnea, the central sleep apnea, is where there's a delay in the signal from your brain telling you to breathe when you're asleep. Your brain is pausing, it’s not telling you to breathe so you have pauses in your breathing at night, but that’s pretty rare.
Dr. Smith: What are the symptoms of sleep apnea in kids and what are some of the things that maybe parents, if they're concerned, or not concerned because they don’t know, could look for which might be a sign that their child has sleep apnea?
Dr. Ehsan: That's a great question. Some of the symptoms are similar to adults, so snoring and pauses in breathing at night or gasping during sleep. Those are symptoms of sleep apnea. Other things that are more common in little kids, they often don't snore as loud as older adults do, but they'll be nosy. If you can hear them breathing at night, if you close your eyes and you're standing at the door and you can hear your child breathing, that may be a sign of sleep apnea. The other thing is that some kids you'll notice symptoms during the day. They're sleepy during the day, they didn't take naps before, now they're suddenly taking naps, they're asleep on the bus to and from school, you're driving to the grocery store 10 minutes away and your child falls asleep every time. Those are signs and that's a sign of excessive sleepiness during the day. The other thing kids have that adults may not have is behavioral problems at school. Very often, these children are diagnosed or confused with ADHD type symptoms, but it's actually sleep apnea that's keeping their brain awake at night, they're not getting restful sleep so they have trouble focusing, trouble staying on task during the day, so when kids see me in clinic, somebody would have diagnosed them whether it's a concern for ADHD when they really have sleep apnea that's causing the daytime problems.
Dr. Smith: What a great point to bring up. I think that’s something all practitioners need to be aware of, right? So many kids being diagnosed with ADHD, maybe we need to think about sleep apnea. They're just not sleeping well at night, so during the day, it's hard to concentrate, they're irritable, there are those behavioral problems, they're falling asleep; it makes sense. What's the negative side here? If we don't treat this, if we don't diagnose it or if we let it go untreated, what're the consequences?
Dr. Ehsan: That's a good question. The immediate negative effects are functioning during the day; poor school performance, decreased cognitive ability to think and behavioral problems during the day. Other long-term negative effects are mainly to your heart. It can have an effect on your heart and other systems in your body. Essentially, you're not sleeping well at night, your sleep is disrupted, your brain is awake all night, there are changes in the oxygen levels in your body so it's stressing your heart, stressing your brain and there's a lot of reports of this leading to high blood pressure later on; heart disease, stroke, diabetes. Untreated sleep apnea going on for years can lead to some of these really major health consequences.
Dr. Smith: How do we diagnose sleep apnea in kids?
Dr. Ehsan: The only way to diagnose sleep apnea in children is with a sleep study. There are some instances in adults where sleep studies can be done in the home, but as of right now, the American Academy of Sleep Medicine recommends getting a sleep study in the hospital or in a sleep laboratory. What happens with that is a child will spend the night in the sleep lab, we will put monitors on their head and chest, nothing hurtful, there's no needles or shots, they spend the night under monitors and we look for pauses in breathing at night, we look at their oxygen levels and we diagnose it based on that.
Dr. Smith: If you do diagnose sleep apnea in a child, how are we treating that today?
Dr. Ehsan: There are different treatment options and it depends on the severity. There's mild sleep apnea and there's more severe sleep apnea. If you have what we call mild sleep apnea, and we’ll need a sleep study to differentiate between those two, mild sleep apnea can be treated with medications. Usually, a steroid nose spray to decrease swelling of the nose and then an oral medication. We usually treat anywhere between three to six months. Treatment options for more severe sleep apnea can include, and it depends on what's causing it, so if your tonsils or your adenoids are big, that’s the most common reason to have sleep apnea in children, and we recommend surgery. If you already had your tonsils out, then we can recommend what we call CPAP, continuous positive airway pressure, wearing a mask attached to a machine. This is different from adults because adults with sleep apnea, the first thing they can get treated with is CPAP. Kids with sleep apnea, the first thing they are treated with in severe sleep apnea is usually surgery or getting your tonsils out. That's slightly different from what we do in adults. In extreme cases, there are other surgeries that we may need to do to treat sleep apnea, again it depends on whether the child has other medical conditions or not and other things.
Dr. Smith: You are a pediatric pulmonologist and you specialize in sleep medicine and I know you're involved and work really hard in the pulmonary clinic at Children’s Mercy. Tell us a little bit about how the pulmonary clinic approaches their patients and family when diagnosing anything to do with the pulmonary system.
Dr. Ehsan: We have a large group of pulmonologists here. We do clinics pretty much at multiple satellite locations within the city and also at the main location in Kansas City, Missouri and downtown. We have several providers doing clinics every day. The way we usually get our patients sent to us is either a referral through the primary care provider or self-referrals or through other subspecialties. We can usually get them to the pulmonary clinic right away so our wait time is less than a week for the most part and within a couple of days. Families are scheduled over the phone, they come in a little earlier, if their appointment is at one o'clock, they asked to come in at around 12:45, they get checked in by the nurse and our care assistants, and then the nurse takes a brief history and the physician will come in and talk to the family. We have other testing available in our clinics like lung function testing or other blood work that needs to be done. We also have some allergy testing available as well. A family can really get multiple things done at the same visit and it's really a multidisciplinary care. We have a social worker there at all times as well to help with other questions a family has or other concerns that they're having. We have a pharmacist available in case children are on multiple medications and there are questions about medications. We have respiratory therapists in our clinic to go over inhalers and how to use them. It's really state of the art care that we're providing here at Children's Mercy.
Dr. Smith: Very nice. I want to thank you for the work that you are doing at Children’s Mercy and thank you for coming on the show today. You're listening to Pediatrics in Practice with Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I'm Dr. Mike Smith. Thanks for listening.
Pediatric Sleep Apnea
Dr. Michael Smith: Our topic today is sleep apnea in children. My guest is Dr. Zarmina Ehsan. Dr. Ehsan is a pediatric pulmonologist who specializes in pediatric sleep medication at Children’s Mercy Kansas City. Welcome to the show.
Dr. Zarmina Ehsan, MD: Thank you so much. Thank you for inviting me to the show.
Dr. Smith: What a wonderful topic. I think a lot of us who practice medicine, and even the late population, I think we know more about the adult side of this problem, but I think we get a little confused about what exactly is sleep apnea in a child. I think this is a great topic. Let's just start with a really nice simple question. What causes sleep apnea in children and is it different from adults?
Dr. Ehsan: You're absolutely right that this is pretty common in adults and we hear about it all the time on the news and on the radio, but pediatric sleep apnea doesn't get as much stress. It’s pretty common so the prevalence is anywhere between 4% to 6% of the population; four to six children out of 100 will have it. It's basically a breathing problem that occurs during sleep. There are two types of sleep apnea. There's the obstructive sleep apnea, or OSA, which is more common and similar to what adults have. There's another type that’s rare that’s called central sleep apnea, or CSA, and the way I like to explain OSA is that there's an obstruction or narrowing in the path from your nose down to the opening of your lungs and this is called the upper airway. From your nose down to right where the lungs open up, that whole path is called the upper airway, and any narrowing there can make it harder to breathe and make it really hard to breathe at night when you're laying down and you're asleep. There can be different reasons for this narrowing or obstruction and we can talk about it a little bit later, but big tonsils, for example, can obstruct that pathway. This all results in less air or oxygen going from the outside into your lungs and results in sleep apnea. The rarer kind of sleep apnea, the central sleep apnea, is where there's a delay in the signal from your brain telling you to breathe when you're asleep. Your brain is pausing, it’s not telling you to breathe so you have pauses in your breathing at night, but that’s pretty rare.
Dr. Smith: What are the symptoms of sleep apnea in kids and what are some of the things that maybe parents, if they're concerned, or not concerned because they don’t know, could look for which might be a sign that their child has sleep apnea?
Dr. Ehsan: That's a great question. Some of the symptoms are similar to adults, so snoring and pauses in breathing at night or gasping during sleep. Those are symptoms of sleep apnea. Other things that are more common in little kids, they often don't snore as loud as older adults do, but they'll be nosy. If you can hear them breathing at night, if you close your eyes and you're standing at the door and you can hear your child breathing, that may be a sign of sleep apnea. The other thing is that some kids you'll notice symptoms during the day. They're sleepy during the day, they didn't take naps before, now they're suddenly taking naps, they're asleep on the bus to and from school, you're driving to the grocery store 10 minutes away and your child falls asleep every time. Those are signs and that's a sign of excessive sleepiness during the day. The other thing kids have that adults may not have is behavioral problems at school. Very often, these children are diagnosed or confused with ADHD type symptoms, but it's actually sleep apnea that's keeping their brain awake at night, they're not getting restful sleep so they have trouble focusing, trouble staying on task during the day, so when kids see me in clinic, somebody would have diagnosed them whether it's a concern for ADHD when they really have sleep apnea that's causing the daytime problems.
Dr. Smith: What a great point to bring up. I think that’s something all practitioners need to be aware of, right? So many kids being diagnosed with ADHD, maybe we need to think about sleep apnea. They're just not sleeping well at night, so during the day, it's hard to concentrate, they're irritable, there are those behavioral problems, they're falling asleep; it makes sense. What's the negative side here? If we don't treat this, if we don't diagnose it or if we let it go untreated, what're the consequences?
Dr. Ehsan: That's a good question. The immediate negative effects are functioning during the day; poor school performance, decreased cognitive ability to think and behavioral problems during the day. Other long-term negative effects are mainly to your heart. It can have an effect on your heart and other systems in your body. Essentially, you're not sleeping well at night, your sleep is disrupted, your brain is awake all night, there are changes in the oxygen levels in your body so it's stressing your heart, stressing your brain and there's a lot of reports of this leading to high blood pressure later on; heart disease, stroke, diabetes. Untreated sleep apnea going on for years can lead to some of these really major health consequences.
Dr. Smith: How do we diagnose sleep apnea in kids?
Dr. Ehsan: The only way to diagnose sleep apnea in children is with a sleep study. There are some instances in adults where sleep studies can be done in the home, but as of right now, the American Academy of Sleep Medicine recommends getting a sleep study in the hospital or in a sleep laboratory. What happens with that is a child will spend the night in the sleep lab, we will put monitors on their head and chest, nothing hurtful, there's no needles or shots, they spend the night under monitors and we look for pauses in breathing at night, we look at their oxygen levels and we diagnose it based on that.
Dr. Smith: If you do diagnose sleep apnea in a child, how are we treating that today?
Dr. Ehsan: There are different treatment options and it depends on the severity. There's mild sleep apnea and there's more severe sleep apnea. If you have what we call mild sleep apnea, and we’ll need a sleep study to differentiate between those two, mild sleep apnea can be treated with medications. Usually, a steroid nose spray to decrease swelling of the nose and then an oral medication. We usually treat anywhere between three to six months. Treatment options for more severe sleep apnea can include, and it depends on what's causing it, so if your tonsils or your adenoids are big, that’s the most common reason to have sleep apnea in children, and we recommend surgery. If you already had your tonsils out, then we can recommend what we call CPAP, continuous positive airway pressure, wearing a mask attached to a machine. This is different from adults because adults with sleep apnea, the first thing they can get treated with is CPAP. Kids with sleep apnea, the first thing they are treated with in severe sleep apnea is usually surgery or getting your tonsils out. That's slightly different from what we do in adults. In extreme cases, there are other surgeries that we may need to do to treat sleep apnea, again it depends on whether the child has other medical conditions or not and other things.
Dr. Smith: You are a pediatric pulmonologist and you specialize in sleep medicine and I know you're involved and work really hard in the pulmonary clinic at Children’s Mercy. Tell us a little bit about how the pulmonary clinic approaches their patients and family when diagnosing anything to do with the pulmonary system.
Dr. Ehsan: We have a large group of pulmonologists here. We do clinics pretty much at multiple satellite locations within the city and also at the main location in Kansas City, Missouri and downtown. We have several providers doing clinics every day. The way we usually get our patients sent to us is either a referral through the primary care provider or self-referrals or through other subspecialties. We can usually get them to the pulmonary clinic right away so our wait time is less than a week for the most part and within a couple of days. Families are scheduled over the phone, they come in a little earlier, if their appointment is at one o'clock, they asked to come in at around 12:45, they get checked in by the nurse and our care assistants, and then the nurse takes a brief history and the physician will come in and talk to the family. We have other testing available in our clinics like lung function testing or other blood work that needs to be done. We also have some allergy testing available as well. A family can really get multiple things done at the same visit and it's really a multidisciplinary care. We have a social worker there at all times as well to help with other questions a family has or other concerns that they're having. We have a pharmacist available in case children are on multiple medications and there are questions about medications. We have respiratory therapists in our clinic to go over inhalers and how to use them. It's really state of the art care that we're providing here at Children's Mercy.
Dr. Smith: Very nice. I want to thank you for the work that you are doing at Children’s Mercy and thank you for coming on the show today. You're listening to Pediatrics in Practice with Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I'm Dr. Mike Smith. Thanks for listening.