Sleep Breathing Disorders in Children

Children are particularly vulnerable to sleep breathing disorders, including Obstructive Sleep Apnea (OSA). Below are key risk factors:

Risk Factors

 

Anatomical

• Enlarged Tonsils or Adenoids: The most common cause, as these structures can obstruct the airway during sleep.
• Craniofacial Abnormalities: Conditions like micrognathia (small jaw), high-arched palate, or midface hypoplasia narrow the airway.
• Obesity: Excess fat around the neck and airway contributes to obstruction.

Allergic or Inflammatory Conditions

• Chronic Allergies or Asthma: Leads to nasal congestion and airway inflammation, worsening obstruction.
• Recurrent Upper Respiratory Infections: Swelling or mucus buildup exacerbates airway narrowing.

Lifestyle and Environmental Factors

• Secondhand Smoke Exposure: Increases airway inflammation and respiratory issues.
• Sleeping Position: Back-sleeping can worsen symptoms in children with airway compromise.
• Fragmented Sleep: Repeated awakenings due to breathing difficulties can impact development.

Prevalence

Sleep-Disordered Breathing (SDB)

• Includes primary snoring to OSA.
• 12-15% of children experience some form of SDB, with primary snoring being the most common.

Obstructive Sleep Apnea (OSA)

• 1-5% of children are affected by OSA.
• More severe than primary snoring, requiring clinical attention.

 

Signs and Symptoms

Parents and caregivers should monitor the following:

• Snoring or noisy breathing
• Pauses in breathing (apneas)
• Restless sleep or frequent awakenings
• Behavioral issues, hyperactivity, or poor attention span
• Bedwetting or night sweats
• Morning headaches or fatigue

Long-Term Risks of Untreated OSA

• Poor growth and development
• Learning difficulties
• Behavioral problems
• Cardiovascular complications (e.g., hypertension)

Diagnosis and Management

OSA in children is diagnosed through sleep studies (polysomnography) and managed through:

• Adenotonsillectomy: First-line treatment, effective in 80-90% of mild cases. Maxillary orthodontic expansion may be required. Recurrence is more likely in obese children and severe cases.
• CPAP Therapy: Used in severe OSA cases or when surgery is contraindicated.
• Weight Management: Addressing obesity-related OSA.
• Orthodontic Treatments: Maxillary expansion and mandibular advancement.
• Allergy Management: Controlling allergies to maintain an open nasal airway.

 

Temporomandibular Joint Disorders (TMD) in Children

Children can also develop TMJ/TMD, leading to headaches and jaw pain.

Prevalence

• 6-12% of children experience TMD symptoms, with myofascial pain being the most common.
• Girls have a slightly higher prevalence, especially post-puberty, likely due to hormonal influences and psychosocial factors.

Types of TMJ/TMD in Children

1. Myofascial Pain (Most Common)
   • Causes: Bruxism (teeth grinding), poor posture (e.g., from excessive screen time or heavy backpack use), excessive jaw muscle use (e.g., gum chewing).

 

Risk Factors for TMD

1. Habits: Bruxism, thumb-sucking, or nail-biting.
2. Stress and Anxiety: Psychological stress can contribute to muscle tension and bruxism.
3. Trauma: Falls, sports injuries, or jaw trauma.

Other TMJ/TMD Conditions

• Traumatic Jaw Injury
• Arthritic Jaw Conditions (e.g., Juvenile Idiopathic Arthritis)
• Developmental Abnormalities

 

Headaches in Children

Primary headaches, including migraines and tension-type headaches, are commonly reported in children.

Prevalence

• Migraine: Affects 4-11% of children, with a higher prevalence post-puberty.
• Tension-Type Headaches: Affects 15-20% of children and adolescents, often linked to stress and posture.

Overlap Between TMD and Headaches

• 25-50% of children with TMD also report primary headaches.
• Among children with migraines or tension-type headaches, 20-30% have TMD symptoms.
• Common Symptoms:
  • Pain Referral: TMD pain can radiate to the temples, mimicking tension-type headaches.
  • Bruxism: Teeth grinding worsens both TMD and headaches.
  • Morning Headaches: Often linked to bruxism or jaw clenching.

 

Importance of Early Detection

Sleep apnea, TMD, and headaches can start in childhood, and comorbidities (multiple overlapping conditions) often persist into adulthood. Early detection and treatment are essential to prevent long-term complications.

Continuation Rates into Adulthood

OSA

• 40-60% of moderate to severe cases persist into adulthood if untreated.
• Childhood obesity-related OSA has a 70-80% risk of persisting.
• Structural airway abnormalities (e.g., retrognathia, high-arched palate) predispose individuals to lifelong OSA.

SDB and Headaches

• 10-15% of children with comorbid SDB and headaches will retain both conditions into adulthood.
• 15-30% of adults with either condition may have undiagnosed comorbidity.

TMD

• 25-30% of children with TMD continue experiencing symptoms into adulthood.
• Bruxism affects 20-30% of children.
• 10-15% of children with SDB also have TMD symptoms.
• 25-50% of children with TMD also report headaches.
• 20-30% of children with comorbid TMD, SDB, and primary headaches continue to experience all three conditions into adulthood.

 

Role of Dentists in Early Detection

Dentists play a crucial role in identifying early signs of craniofacial growth abnormalities, recommending medical referrals, or initiating orthodontic/orthopedic interventions. Various surgical and non-surgical treatments exist to manage Sleep-Related Breathing Disorders (SRBD), improving overall quality of life.