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SINGAPORE : Like both his parents, seven-year-old Muhammad Dzulqarnain snores in his sleep. But unlike them, his snores are so loud they resonate throughout the house every night.
“You can hear him even when the door to his bedroom is closed. Sometimes I joke to my wife how our son’s sleeping style is like ours,” said his father, Mr Mustafa bin Ali.
Jokes aside, Mr Mustafa has every reason to worry.
A mere three years old when his parents began noticing his loud snoring, Dzulqarnain was diagnosed with obstructive sleep apnea (OSA) early this year.
Habitual snoring is one of the tell-tale signs of OSA.
Children with this condition can actually stop breathing from “a few seconds to as long as a few minutes” in their sleep, said Dr Chng Seo Yi, a consultant paediatrician at National University Hospital’s University Children’s Medical Institute.
“During this episode, oxygen levels in the child can drop,” she said.
When Dzulqarnain went through an overnight sleep test in NUH in April, his father was shocked to learn that he had stopped breathing “at least six times” and his oxygen levels dropped to about 60 per cent (the normal range is about 95 per cent) in his sleep.
Adults can suffer from OSA, too, but Dr Chng said that the condition is especially dangerous in children because “their brains are still developing”. Left untreated, OSA in children can lead to delay in development, poor growth, poorer academic performance, as well as behavioural and neurocognitive disorders such as ADHD. Severe complications include heart failure and death.
According to Dr Chng, up to 3 per cent of Singapore children experience OSA. And the number may rise. She estimated that the NUH paediatrics department currently sees approximately 150 OSA cases each year — up from just 60 cases a year five years ago.
Over at KK Women’s and Children’s Hospital’s (KKH) sleep service, the number of young patients with sleep problems has also “almost doubled” since five years ago, said Dr Jenny Tang, deputy head of the department of paediatric medicine, and head and senior consultant of the respiratory medicine service at KKH.
The hospital’s sleep service now sees more than 1,000 children each year with sleep problems.
KKH’s sleep disorder centre runs about 450 overnight sleep studies each year, of which 45 per cent of the cases are OSA-positive.
Dr Tang attributed the increase in the number of patients with OSA to the increase in the number of patients with diseases linked to it, such as asthma and allergic rhinitis.
The increase could also be due to “Singaporean children getting fatter”, said Dr Chng. Obesity can cause excess fatty tissue to narrow the sides of the airway, causing breathing obstruction.
But more often than not, the culprit causing the obstruction in the child is his tonsils and adenoids (a mass of tissue located in the back of the nose).
“Between the ages of three and eight, children tend to have relatively large tonsils and adenoids in proportion to their airway,” explained Dr Chng.
That is why surgery — to take out the tonsils and adenoids — is often used to treat most children who are diagnosed with OSA.
Dzulqarnain went through the surgery last month, which seemed to have helped improve his sleep.
“My concern was that he wasn’t getting enough oxygen in his sleep. He still snores a little but at least there is an improvement in his oxygen levels,” said Mr Mustafa.
However Dr Tang said that not all cases of obstructive sleep apnea in children are easily picked up.
Unlike Dzulqarnain’s nightly snoring, symptoms in other children “can manifest in more subtle ways and is frequently missed or under-diagnosed”.
“Children may not snore as loudly as adults. They may have more symptoms towards the latter part of sleep when there is more REM sleep. Parents may not notice as they are also sleeping at that time,” said Dr Tang. During REM (Rapid Eye Movement) sleep, OSA is usually more severe.
And if the rest of the family snores, they may think that snoring in children is normal, she added.
Another useful clue that a child has OSA may lie in his sleeping position. “A child who has difficulty breathing may sleep in an unusual sleeping position, such as sitting up to sleep,” said Dr Chng. - TODAY/rose
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