ALLERGIES THAT AFFECT the upper airway can cause problems such as rhinitis (i.e., inflammation of the lining of the nasal cavity), enlarged adenoids and tonsils, and tongue swelling. These allergy reactions can narrow the upper airway, which can contribute to obstructive sleep apnea (OSA) in children. However, allergy is often overlooked as a risk factor for OSA in children.
OSA is a sleep disorder in which a child stops breathing off and on during sleep. The cessation in breathing (i.e., apnea [pronounced “AP-nee-uh”]) occurs because upper airway muscles relax excessively during sleep, which allows structures such as tonsils and adenoids to collapse into and block (i.e., obstruct) the upper airway. The obstruction restricts airflow, and the oxygen level in the blood consequently falls. A child struggles to breathe during the obstruction. When the blood oxygen level falls to a certain point, the child arouses briefly to take several deep, quick breaths, which restores the blood oxygen level. During these quick breaths, snoring and gasping for air often occurs. Once the blood oxygen level returns to normal, the child resumes sleep, which may set the stage for another episode of apnea.
Owing to frequent arousals from sleep, a child with OSA may struggle with daytime sleepiness, some consequences of which are falling asleep in class, difficulty concentrating, and poor grades. Some children with OSA may also have bedwetting and hyperactive behavior.
Most children with OSA have enlarged tonsils. Enlarged adenoids and tonsils typically occur in association with an infection. In some cases, no infectious cause can be determined. However, some research indicates that enlarged tonsils can be caused by an allergy.
An allergy is an excessive immune response to a normally harmless noninfectious substance (i.e., an allergen [pronounced “AL-er-jen”]) such as pollen, cigarette smoke, dust mites, and food. In the upper airway, typical allergic responses are coughing, sneezing, itchy eyes, runny nose, stuffy nose, and scratchy throat.
The adenoids and tonsils are part of the immune system. An allergic response may alter the normal function of these tissues, thereby contributing to their enlargement and consequently to OSA.
A common treatment for OSA in children is continuous positive airway pressure (CPAP). In this treatment, pressurized air is blown through the upper airway via a mask that fits over the nose or over the nose and mouth. The pressure prevents the upper airway from collapsing during sleep. Another treatment is the removal of the adenoids and/or tonsils. With these tissues removed, the airway is more open, thereby preventing obstruction of the upper airway.
If your child has allergies and you note symptoms of OSA, you may want to consider having your child assessed at a sleep disorders center to determine whether your child has OSA and, if so, the severity of the disorder. For some children with mild cases of OSA, treating allergies may be beneficial. For example, removing exposure to an allergen (e.g., avoiding foods that trigger an allergic response or avoiding cigarette smoke) can reduce immune responses in the upper airway, which may improve OSA symptoms or reduce a child’s need for CPAP treatment or adenotonsillectomy.
Regina Patrick, RPSGT, RST, is a freelance writer/editor and a registered sleep technologist. She has been involved in the sleep field for more than 30 years.
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