Wednesday, June 21, 2006

Snoring

Dear Lisa,

My 5 year old son snores really loud and sounds just like my husband. I’ve tried changing his position while he is sleeping and it doesn’t make a difference. Is this normal?

“Mother of a Snoring child”

Dear “Mother of a Snoring child”,

During normal sleep a child’s respirations become more shallow and the muscle tone of the upper airway decreases. As a result the airway becomes floppy which leads to upper airway resistance and in some cases snoring sounds. (1) Snoring may occur intermittently with a cold or allergies because the nasal passages become blocked with mucus. On the other hand, if a child has chronic or loud snoring, especially with pauses in the breathing, an evaluation for Obstructive Sleep Apnea is warranted.

Children with enlarged tonsils and/or adenoids, low muscle tone, obesity, Down’s syndrome, Cerebral Palsy, a large tongue, a small oral airway, small nasal airway or children taking sedatives are at risk for Obstructive Sleep Apnea. (2,3) Signs of Obstructive Sleep Apnea may include excessive sleepiness during the day, hyperactivity during the day, nocturnal enuresis (bedwetting), night time awakenings, Attention Deficit Disorder, restless sleep, poor school performance, mouth breathing, behavioral problems, loud snoring or stridor. (4,5,6)

If Obstructive Sleep Apnea is a concern, an Ear Nose Throat (ENT) Specialist can evaluate your child’s upper airway and determine if he is at risk. In order to better describe your child’s symptoms to the specialist it is a good idea to bring a camcorder videotape including visual and sound effects of your child’s nighttime snoring to the evaluation. In some cases an overnight test performed in a Sleep Lab called a Sleep Study may be ordered in order to better evaluate your child’s nighttime breathing pattern and rule out Obstructive Sleep Apnea.

References:
(1)Rosen G. General Overview of Neuroanatomy and Neurophysiology of Sleep. Presented at: Pediatric Sleep Disorders Conference;May 31, 2002:Edison.
(2)Sleep Apnea. Clinician Reviews. 2006;16(6):25.
(3)Behrman R, Kliegman R. Nelson Essentials of Pediatrics. Philadelphia, PA: W.B. Saunders Company. 1990:438.
(4). Picchietti, D., England, S., Walters, A., Willis, D., Verrico, T. Periodic Limb Movement Disorder and Restless Legs Syndrome in Children with Attention deficit Hyperactivity Disorder. Journal of Child Neurology.1998;13(12):588-594.
(5)Dahl, R., Pelham, W., Wierson, M. The role of sleep disturbances in attention-deficit disorder symptoms: A case study. J Pediatr Psychol. 1991;16:229-239.
(6) Kaplan, B., McNicol J., Conte, R., Moghadam, J. Sleep disturbance in preschool-aged hyperactive and nonhyperactive children. Pediatrics. 1987;80:839-844.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

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