Mouth Breathing and Disturbed Sleep in Children

Understanding its importance in Physical and Mental Wellbeing of a Child and ways to improve it

A blog by Dr. Shahriyar Azad

Sleep is vital for proper growth and physical as well as mental wellbeing of all the children. In this blog we will dive deep to understand the altered sleep conditions which can pose a serious health risk to a child and the ways to improve and enhance proper sleep.

‘Sleep-disordered breathing’ (SDB) is a syndrome of upper airway dysfunction which is characterized by mouth breathing and/or snoring, increased respiratory effort and frequent arousals from sleep which leads to poor quality of sleep in a child.

Snoring or noisy breathing during sleep can be the first sign that draws the parents’ attention that child is not sleeping well. It can be the tip of the iceberg and needs a proper evaluation.

The extreme end of the spectrum can be “Obstructive Sleep Apnoea” which needs to be taken care of in children as it had serious health concerns.

Obstructive sleep apnoea (OSA) is defined as pauses in breathing during sleep, that frequently occur with snoring, mouth breathing and occasional gasping which can cause a drop in child’s oxygen levels because of disrupted breathing.

OSA occurs in 1% to 5% of all children which means that around “20 million” children worldwide are affected.

Why does it happen?

In adults, obesity is the commonest cause (58%) of OSA but in children the most common associations of obstructive sleep apnoea in are “large tonsils and adenoids”.

Enlarged tonsils and adenoids can further add to the problem when a child’s throat relaxes during sleep and they fall back which can block air flow causing child to wake up for a short duration to consciously breathe and falls sleep again.

What are the other symptoms?

The child can have noisy or laboured breathing while sleeping?or frequent pauses between breaths or gasping for a breath while sleep and the child is not aware of all this. This leads to a very restless sleep and the child sleeping in unusual positions.

Moreover, daytime sleepiness or behavioural problems can be noticed.

Other symptoms include poor weight gain, failure to thrive, bed-wetting and sometimes apnoea can affect school performance.

How do we diagnose SDB?

Once child is not able to sleep well at night for many nights continuously it can lead to associated complications. Therefore, it is mandatory to take medical help for proper assessment. It’s a multidisciplinary management and includes a Paediatric ENT Specialist for an in-depth analysis and proper examination of the airway and General Paediatric Specialist for the Overall assessment and examination of chest.

The child may require a Camera test for assessment of back of the nose and upper airway by ENT specialist or Radiographic film (X-Ray). The Gold standard is Polysomnography, commonly known as a sleep study, is a test helps to diagnose sleep disorders.

How do we address the concern?

The management protocols followed worldwide depend on the severity and type of the sleep disorder.

After proper assessment if the child fails the test, the parents are offered   Surgical or a Medical Management for management of the child. The surgical procedures include removal of Adenoids & Tonsils (day surgery) and newer technique which include Coblation Tonsillotomy (reducing and not removing the tonsils) and a Coblation Adenidectomy.

Others treatment Modalities Include CPAP/BiPAP (a mask and machine system), Weight Reduction and Management of other medical comorbidities.

For any more queries or explanations, you can book a consultation with Dr. Shahriyar Azad today!