Children snore

Patient's question:

My son is seven years old this year. Since this winter, he has been snoring very noticeably. He used to snore a little, but not loudly. Now he snores every day, and there are episodes of gasping for breath. I would like to ask what factors or causes this, and how it should be treated?
First follow-up question: (2007-12-10 17:11:42) The explanation from the older brother was too "clear," but what I need is an analysis and answer from my child's perspective. Thank you!
Second follow-up question: (2007-12-11 11:37:43) Thank you. Regarding the comment from the doctor below, because your accent is quite strong, I can't understand it.

Doctor's answer:

Snoring is a common sleep phenomenon, and most people currently consider it a normal occurrence without much concern. Some even view snoring as a sign of sound sleep. In reality, snoring is a major enemy of health. Due to snoring, sleep breathing repeatedly pauses, causing severe hypoxia in the brain and blood, leading to hypoxemia. This can trigger high blood pressure, coronary heart disease, arrhythmia, myocardial infarction, and angina. If the pause in breathing exceeds 120 seconds at night, sudden death is likely to occur in the early hours of the morning.
In April 1994, an international snoring symposium was held in Beijing, where experts and scholars from various countries identified snoring as "sleep apnea syndrome," a condition or symptom complex associated with 27 different diseases. How is it defined? A pause of more than 10 seconds is considered one episode of apnea. If there are more than five pauses of over 10 seconds during an hour of sleep, or approximately 30 such pauses over seven hours of sleep, it is classified as sleep apnea syndrome. It poses significant harm to the human body. One-third of a person's life is spent sleeping. Normal individuals breathe evenly during sleep, with oxygen intake meeting the needs of all body parts. However, those who experience breathing pauses every night for seven hours may spend 300-400 seconds in an oxygen-deprived state, with blood oxygen levels about 8-10% lower than normal. Night after night, year after year, fragmented sleep leads to a significant reduction in oxygen intake, causing ischemia and hypoxia in vital body parts, triggering various serious diseases. If brain cells are deprived of oxygen for 4-6 minutes, irreversible cell death occurs. 53% of patients experience cerebrovascular accidents during nighttime sleep. Recent studies indicate that snoring and apnea are independent risk factors for cerebrovascular disease, being a major or one of the causes of its onset. Snoring sharply increases mortality at night. Untreated snoring with a history of about five years has a mortality rate of 11%-13%. For those with a snoring history of more than eight years and more than 15 pauses per hour, the mortality rate rises to 37%. 72.5% of wives with snoring husbands sleep 1-2 hours less per night, and 30.6% are woken up by the snoring. 9.7% of women suffer from neurasthenia due to their husband's snoring (though the impact of snoring on marital breakdown remains unproven). It is clear that snoring is not a normal phenomenon but a serious disease, a source of other diseases.
Snoring during sleep is a common occurrence in daily life. Most people are aware that snoring can disturb others' sleep, but experts at the Nursing Center of Fujian Provincial Hospital remind that snoring may also be a warning sign of sleep apnea syndrome and can pose numerous health risks.
According to experts, snoring is medically known as snoring and is a primary clinical manifestation of sleep apnea syndrome. It not only causes daytime sleepiness and fatigue in the snorer but may also be associated with certain respiratory diseases and cardiovascular conditions such as hypertension, coronary heart disease, and cerebrovascular accidents.
Experts state that if snoring occurs at night and is accompanied by the following symptoms, it is a warning sign from the body, and immediate medical attention is required: snoring during sleep, mouth breathing, frequent pauses in breathing; recurrent awakenings during sleep, restless sleep, epilepsy; lack of refreshment after sleep, daytime fatigue, drowsiness; elevated blood pressure upon waking; light sleep, headaches upon waking; nocturnal sleep-related angina, arrhythmia; nocturnal enuresis, increased nocturia; memory loss, slow reaction, reduced work and learning ability; daytime drowsiness, difficulty resisting sleep during work, meetings, or meals; impotence, decreased libido; and Alzheimer's disease.
In addition to medical treatment, the following measures can be taken in daily life to alleviate snoring symptoms: sleeping in a side position to change from the habitual supine position; avoiding alcohol before bed, as well as strong tea, coffee, and certain medications, as alcohol, sedatives, sleeping pills, and antihistamines can make breathing shallow and slow, and relax muscles, leading to easier blockage of the airway by soft tissues in the pharynx; developing a regular exercise habit to reduce weight and enhance lung function.
Experts also specifically remind snorers to quit smoking immediately. Only by maintaining clear nasal and pharyngeal passages can snoring be reduced, and smoking only worsens already blocked nasal and respiratory passages. Additionally, snorers should prevent colds and promptly treat nasal obstructive diseases.
1. How is your sleep quality?
Some may ask, "I've slept for 10 hours straight but still feel tired and sleepy, while others feel energetic and refreshed after sleeping for 45 hours. Why is that?" This is the issue of sleep quality. Good or bad sleep is mainly determined by the amount of deep sleep (stages 3 and 4) one gets. If your deep sleep time is short or even non-existent, with mostly light sleep (stages 1 and 2) for 10 hours or more, you will still feel fatigued and drowsy. If your deep sleep time is long, with little light sleep, even if you only sleep for 5-6 hours, you can still be energetic and healthy. Therefore, the focus is on sleep quality, not duration.
If you want to understand your sleep quality, a polysomnogram can be used for detailed monitoring.
2. When should you consider sleep disorders?
Unhealthy sleep patterns include snoring, mouth breathing, and even temporary cessation of breathing. Recurrent awakenings during sleep, restless sleep, frequent nocturnal angina and arrhythmia, headaches upon waking, dizziness, high blood pressure in the morning, daytime fatigue, weakness, drowsiness, even falling asleep during work, meetings, or driving, memory decline, slow reaction, reduced work and learning ability, decreased sexual function, impotence, etc. If you experience any of these symptoms, you should highly consider sleep disorders or obstructive sleep apnea syndrome. The first step is to have an ear, nose, and throat examination and undergo a polysomnogram.
3. Snoring is also a disease
In the past, snoring was thought to be a sign of good sleep, but people are now gradually realizing that it may be a pathological condition. Snorers are often by others, and their relationships with roommates or spouses may become strained, causing distress. However, the greater harm of snoring is causing breathing pauses. Snorers' airways are narrower than normal, and in severe cases, the airway can be completely blocked, leading to pauses in breathing. During pauses, oxygen cannot enter the lungs, causing oxygen deprivation and carbon dioxide retention. Severe cases can lead to high blood pressure, heart disease, arrhythmia, cerebrovascular accidents, diabetes, kidney disease, hypothyroidism, and even sudden death during sleep.
4. What is the mechanism of snoring?
Snorers' airways are usually narrower than normal. During waking hours, the throat muscles compensate by contracting, keeping the airway open and preventing blockage. However, during sleep, when nerve excitability decreases and muscles relax, throat tissues can block the airway, causing the upper airway to collapse. When air flows through the narrowed area, it creates eddies and vibrations, resulting in snoring. In severe cases, breathing can temporarily stop, affecting health. In addition, a small number of people snore due to central factors or causes.
5. Common causes of snoring and apnea
Narrowing of the respiratory tract, primarily above the trachea, due to various factors or causes can lead to snoring or apnea. This includes: deviated nasal septum, nasal polyps, etc., causing nasal narrowing; pharyngeal narrowing: enlarged tonsils, relaxed pharynx, long uvula; enlarged tongue, tumors at the base of the tongue, posterior tongue attachments; facial and jaw deformities, such as micrognathia; obesity. In children, snoring is often due to enlarged adenoids and tonsils or facial structural deformities. Due to significant obstructive airway lesions, apnea is more likely to occur, leading to oxygen deprivation and affecting normal development and learning in children. It has been reported that severe snoring can cause pediatric dementia. Therefore, if your child snores at night and shows signs of inattention in class, drowsiness, memory decline, and poor academic performance, it is essential to have an ear, nose, and throat examination to check the nasal pharynx and tonsils. If they are significantly enlarged, appropriate treatment should be administered.
6. General treatment for snoring
Treatment for snoring depends on the specific factors or causes and may vary. The choice of treatment is the most critical factor in determining its effectiveness. We will discuss the main methods for treating snoring in four parts. First, we will discuss general treatment. Weight loss: Obesity is one of the factors that can cause pharyngeal narrowing. Losing weight can reduce the severity of airway blockage. Quitting smoking and alcohol: Smoking can irritate the throat, causing inflammation and edema, while alcohol can relax muscles and cause the tongue to fall back, worsening blockage. Additionally, not taking sedatives or sleeping pills before bed and sleeping on your side can also help alleviate snoring.
7. Surgical treatment for snoring
Different surgical methods are chosen based on the level of blockage. For patients with nasal obstruction, nasal surgery may be performed to clear the nasal passages. For those with pharyngeal narrowing, uvulopalatopharyngoplasty can be performed. This surgery involves removing part of the uvula and tonsils to increase the space in the pharynx, thus treating snoring. It is the most commonly used surgical method for treating snoring and sleep apnea. Its success depends on the selection of surgical candidates. Additionally, patients with micrognathia, who are prone to tongue collapse, may undergo orthognathic surgery.
8. Plasma for snoring
Plasma technology is a recent patented technology from the United States. It is a minimally invasive treatment with great potential. It can cause pharyngeal tissue to ablate and shrink, and can also reduce the size of an enlarged tongue. Due to its low-temperature treatment, local reactions are minimal, with little or no pain, minimal or no bleeding, short operation time, and can be performed on an outpatient basis. It is mainly suitable for patients with nasal and pharyngeal narrowing and an enlarged tongue. The Department of Otolaryngology at Nanjing 8th Hospital has used plasma ablation technology to treat many patients with good results.
9. Treatment for snoring with CPAP and oral appliances
The main principle of CPAP (Continuous Positive Airway Pressure) is to wear a small CPAP machine during sleep, connect it to a mask, and expand the narrowed parts of the pharynx, similar to blowing up a balloon. The pressure required for each patient is different, so a doctor needs to determine an appropriate pressure using a polysomnogram. CPAP can significantly increase blood oxygen levels and is suitable for moderate to severe snoring and patients who have not responded to other treatments.
10. Conclusion
Snoring and sleep apnea syndrome can cause serious consequences for multiple body systems, affecting health. A polysomnogram is the primary tool for diagnosing snoring. Treatment should be chosen based on the specific condition of the patient. The Department of Otolaryngology at Nanjing 8th Hospital's Sleep Disorders Center has implemented all the treatment methods mentioned above, including surgery, radiofrequency, CPAP, and anti-snoring devices. Essentially, 95% of snoring patients can achieve satisfactory results through different treatment methods.