STORY BYGetting enough sleep is a challenge for many adults, but now the number of children with sleep disorders is increasing. Some 70 million Americans have this problem. Six out of every 10 of those under 18 complain of being tired during the day.
Staying up late, however, is not the only reason the young are yawning.
“Breathing and sleeping go hand in hand. You must breathe well to get a good night’s sleep, which means feeling rested when you awaken,” explains pulmonologist and sleep expert Dr. Richard Castriotta, director of the Division of Pulmonary, Critical Care and Sleep Medicine at The University of Texas Medical School at Houston.
“In fact, the most common sleep disorder causing daytime sleepiness is the breathing problem, sleep apnea. This is one reason that so many lung specialists have become involved with sleep medicine.”
In sleep apnea, a person regularly stops breathing during sleep for 10 seconds or longer. (An occasional stop in breathing is normal.) Classifications are mild, moderate or severe based on the number of times per hour you stop breathing. This can happen from five to 50 times an hour. The two types are obstructive sleep apnea and central sleep apnea.
Obstructive sleep apnea, a major problem with children ages 3 to 12, is believed to be associated with hyperactivity.
“Scientists, who have found a link between difficulty with breathing and behavioral and learning problems, believe that many children who are diagnosed with ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder) actually have sleep apnea,” Castriotta says. “When a child’s breathing is disturbed often during the night, it results in being overly tired the next day. Instead of the child being sleepy, he or she will be hyperactive.”
Symptoms are snoring and snorting loudly as well as inattention or difficulty concentrating in school and hyperactivity. During sleep, the airway is blocked. The obstruction is usually enlarged adenoids or tonsils or both.
“A simple tonsillectomy and adenoidectomy will frequently solve the problem. Another potential benefit is that hyperactivity decreases in some of these children,” he observes.
Forty percent of children who snore have sleep-disordered breathing. “This is such a big risk factor that we recommend that children who snore be evaluated as soon as possible.”
Obstructive sleep apnea, the most common organic cause of daytime sleepiness, affects five percent of the general population, including both adults and children. It increases in certain groups. Some 40 to 50 percent of morbidly obese people have sleep apnea because excessive fat restricts the breathing passages.
Other symptoms of obstructive sleep apnea are excessive daytime sleepiness, restless sleep, difficulty in breathing during sleep and morning headaches.
During an apnea episode, a person’s blood oxygen level may drop. The major effects are associated with the transient arousals which occur in order to allow the individual to open up the blocked airway and start breathing again. Over time, this can lead to serious health problems and early death. People who have sleep apnea may be at greater risk for developing high blood pressure, depression, irregular heart rhythms, heart disease and stroke. As many as 60-70 percent of people with stroke have sleep apnea, and most people with stroke should be evaluated.
“The youngest patients are the premature neonates, who are born with deficient breathing mechanisms,” Castriotta says. A very rare condition called Ondine’s Curse is when a child has no spontaneous breathing during sleep. These children can be fitted with pacers that stimulate the diaphragm to move and breathe. This condition lasts for the rest of their lives.
“A much more common problem is apnea of prematurity, which is a predominantly central sleep apnea. In central sleep apnea of all types, the brain just does not tell the child to breathe. He or she just quits breathing because of poorly developed central nervous and respiratory systems.”
Adolescents qualify as adults, however, when performing adult activities, such as driving. Sleepy drivers are dangerous, no matter what their ages.
“Insufficient sleep is similar to alcohol when it comes to motor skills,” Castriotta points out. The National Highway Traffic Safety Administration notes that at least 100,000 police-reported car crashes annually are the direct result of driver fatigue. Sleepiness is the most common cause of highway fatalities. There is a movement to regard drowsy driving as a crime, similarly punishable as driving while intoxicated.
A “Maintenance of Wakefulness Test” is used on bus and truck drivers and airplane pilots before allowing them to get behind the wheel after being diagnosed with a sleep disorder such as sleep apnea or narcolepsy. The test is done in a sleep laboratory and evaluates a person’s ability to stay awake in uninterrupted, boring conditions.
Castriotta says that children and adolescents now make up 20 to 30 percent of the patients who come through the Sleep Disorders Center at Memorial Hermann Hospital-Texas Medical Center, where Castriotta, as medical director performs sleep studies.
UPDATED: 1-26-2006
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Dr. Richard Castriotta is director of the Division of Pulmonary, Critical Care and Sleep Medicine at UT Medical School.
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