00:07Thank you so much. My name is Dr. Fantao Nala Musaggaw, a consultant pediatrician,
00:12pediatric emergency cell specialist, working at PAHO International Hospital, Kigali, Rwanda.
00:19A sleep apnea is a condition that makes a person stop breathing for a few seconds,
00:26maybe like 10 seconds during sleep, despite adequate effort of breathing.
00:34So the most common cause is called obstructive sleep apnea.
00:39This sleep apnea with difficulty of breathing occurred due to airway obstruction.
00:45We say air obstruction can be partial, halfway or complete air obstruction during sleeping.
00:52Obstructive sleep apnea is common in children from 1% to 5% of all ages.
01:00It can occur at any age, but the most peak age of occurrence is from 2 years up to 6
01:06years.
01:07When you see the cause of obstructive sleep apnea, there are lists of causes of obstructive sleep apnea.
01:14The first is enlargement of the adenoid and tonsil, we call it adeno tonsillar hypertrophy.
01:21The second is allergy of the nose that causes obstructive sleep apnea during sleep.
01:29The third cause is, in adolescence and older children, obesity.
01:34Obest children could have obstructive sleep apnea.
01:37Either the fourth cause, anatomic abnormality of the face that can affect the airway,
01:43can result in sleep apnea at night.
01:47And the fifth cause is when a nerve condition or muscle condition that affect,
01:53disease that affect the airway can cause obstructive sleep apnea.
01:58But the most common cause in children, especially from 2 years to 6 years, is enlargement of the adenoids
02:06and or the tonsils.
02:09So when you say enlargement of adenoids and tonsils, the adenoids and tonsils can enlarge.
02:13The tonsils are lymphoid tissues at the back of the mouth, the throat,
02:19and adenoids are also lymphoid tissue at the back of the nose, higher up in the throat.
02:26They are normally present in children, but they can be enlarged due to exposure to different allergens
02:34or repeated infections.
02:37So when they enlarge, they can obstruct the airway passage and cause obstruction during sleeping.
02:44That's why it causes obstructive sleep apnea during sleeping, which is the most common cause.
02:49So when children have obstructive sleep apnea,
02:53the symptoms divide into three.
02:58The first is the nighttime symptom, which we really noticed most commonly.
03:03The second is daytime symptoms.
03:05The third is the consequence.
03:07When you say the nighttime symptoms, they usually have snoring.
03:10Snoring is the landmark of obstructive sleep apnea.
03:13Not all children with snoring have obstructive sleep apnea, but almost all children with obstructive sleep apnea have snoring.
03:23Most all.
03:24Other symptoms are like nighttime frequent awakening because of the difficulty of breathing
03:31and then they pause during breathing, followed by a gasping type of breathing, and they awaken from their sleep,
03:38which is more frequent at night.
03:40And they usually breathe with mouth open because of the airway obstructed.
03:45They have to breathe with mouth open during sleeping to make the airway apparent.
03:50They could have irritability, like difficulty of sleeping, moving around a bit.
03:59Sometimes they can pass urine during night without awareness or they can be awoken for frequent urination.
04:08During the daytime, because of difficulty of sleeping and difficulty of breathing at night,
04:14during the daytime, they will have commonly headache.
04:18They suffer from headache, especially in the morning.
04:21They can have chronic mouth breathing and dryness of the mouth and excessive sleepiness.
04:29Even at school, they can suffer from this.
04:33And usually they will have weight, failure to weight gain or full weight gain or growth.
04:41The consequences of which would be memory loss and they could have behavioural abnormality
04:51and they can also have irritability, lack of attention at school and poor performance at school.
04:59And also, if not treated timely, it can result in abnormality or disease in the lung and the chest.
05:06So this is a consequence that we encounter in obstructive sleep apnea.
05:12Well, the diagnosis is usually made clinically.
05:15It is based on this, all the symptoms.
05:18The doctor can easily diagnose obstructive sleep apnea.
05:22Especially if the child has two of the following, most likely suffering from obstructive sleep apnea.
05:30The first is snoring during sleeping.
05:33The second is difficulty of breathing with or without pause in breathing during sleeping.
05:39The third is daytime sleepiness, irritability, behavioural change or learning problem.
05:45Probably he is suffering from obstructive apnea clinically.
05:49It can be diagnosed with other possible method of diagnosis.
05:53We usually have also x-ray for diagnosis of adenoid enlargement, neck x-ray.
05:59There are so-called sleep tests to diagnose obstructive apnea but commonly clinically diagnosed
06:09and to check the enlargement of the tonsils by opening the mouth.
06:14And we have lateral x-ray of the neck to check the enlargement of the adenoid.
06:19Well, once diagnosis is made, the management, there are two options for management.
06:25The first is medical, the second is surgical.
06:28When we say medical management, we use medicines for a child having allergic rhinitis,
06:35allergy of the nose, asthma that can contribute for obstructive apnea to be treated adequately
06:41with medicines of sprays to the nose or nasal decongestants or treatment of asthma also.
06:51If there is infection, the infection has to be treated.
06:54But the main stage of management and the definitive one is surgical management for adenotonsillar hypertrophy.
07:00So when the tonsils and all the adenoids are enlarged, the definitive management is removing
07:07these tonsils and adenoids, we call it adenotonsillar, adenotonsillectomy.
07:14So removing these can cure almost 100% and removing adenoid tonsils usually doesn't result
07:20in significant immune deficiency.
07:23So there is no major risk of immune deficiency after removing.
07:29If the patient is suffering from obstructive apnea due to adenotonsillar hypertrophy,
07:35tonsillectomy or without adenotonsillar hypertrophy should be done.
07:39The first thing that the parents have to do for a child having obstructive apnea,
07:48if these symptoms are noticed, they should bring to a pediatrician or any doctor,
07:56any specialist dealing with the ear, nose, throat to evaluate the child.
08:04And there are four things they need to help the child at home.
08:09The first is helping their children by making home smoke-free.
08:18Making home free from smoke, any form of smoke,
08:22that helps the child decrease the aggravation of this obstructive apnea during sleep.
08:31The second is if the child has asthma or allergic rhinitis,
08:36they need to help getting the treatment of this condition by bringing to a health specialist.
08:44The third is for obese children,
08:47they need to help decrease the weight of their child
08:51so that the obstructive sleep apnea can reduce.
08:56The other thing is helping them not to sleep by their back flat
09:02and avoiding supine pollution.
09:07When these children having obstructive apnea,
09:11if they sleep with their back supine, the obstructive is more severe.
09:15Because the reason why sleep apnea or difficulty breathing
09:20with pausing breathing during the night during sleeping is
09:23during sleeping the airway collapses
09:26and the breath center of the brain usually does not respond fast
09:31or decrease oxygenation
09:33so that they can have difficulty breathing followed by pausing breathing
09:38followed by awakening from their sleep.
09:42So I recommend to sleep either in a lateral position
09:47or with a pillow under the neck.
09:51This is all but I need to advise for parents
09:57if their children suffering from snoring at night
10:02with difficulty breathing and frequent awakening from sleep
10:07they have to bring to health professionals
10:11to evaluate for obstructive sleep apnea
10:13and get treatment timely before consequences appear.
10:18Thank you so much.
