If your baby likes to snore, is he really sleeping soundly?

In recent years, sleep apnea in children has been increasingly valued and alerted by parents and society due to its high prevalence and serious long-term complications. According to the data in the "Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea in Children in China" (hereinafter referred to as the "Guidelines") jointly compiled by the Pediatric Group of the Chinese Medical Association's Otolaryngology and Head and Neck Surgery Branch, the Respiratory Group of the Chinese Medical Association's Pediatric Surgery Branch, the Chinese Medical Association's Pediatric Surgery Branch and other authoritative academic organizations, the current prevalence of obstructive sleep apnea in children in the United States is 1.2-5.7%, and in Hong Kong, my country, it is 4.8%. According to the results of a Chinese children's sleep monitoring and sleep disorder epidemiological survey recently participated in by Harbin Children's Hospital, the incidence of sleep disorder-related symptoms among children in the city is as high as 20-30%, and about 10% of children have frequent snoring during sleep.

The above-mentioned "Guidelines" warn that if obstructive sleep apnea syndrome (OSA) in children is not diagnosed and effectively intervened in time, a series of serious complications will occur, such as maxillofacial developmental abnormalities, behavioral abnormalities, learning disabilities, growth retardation, neurocognitive damage, endocrine and metabolic disorders, hypertension and pulmonary hypertension, and even increase the risk of cardiovascular events in adulthood. Therefore, early detection, early diagnosis and early intervention of OSA in children will help improve prognosis and have great practical significance.

One third of a person's life is spent sleeping. Sufficient sleep is necessary for important physiological processes such as energy and physical recovery, immune regulation, memory improvement, endocrine regulation, and children's growth and development. Sleep quality is related to children's physical development, while sleep disorders can directly damage physical health and even affect children's intelligence.

Snoring and sleeping with the mouth open, pay attention to it. In daily life, when seeing their children snoring at night and sleeping with their mouths open, many parents are often very relieved, thinking that their children have played all day, or are tired from studying during the day, so they sleep so soundly! Little do they know that behind this surface phenomenon is often a big "trap" - the child is likely to suffer from "adenoids hypertrophy". In an interview with reporters, Fu Haiwei, a member of the Respiratory Sleep Collaboration Group of the Pediatric Branch of the Chinese Medical Association and director of the Sleep Department of Harbin Children's Hospital, warned that snoring is a type of sleep disorder syndrome, and many children have it caused by adenoids hypertrophy. When children often snore when they sleep, parents must pay special attention and ask more questions why?

Guoguo, a 6-year-old boy, snored like his grandfather every night when he went to bed 2 months ago. At first, the child's grandmother was very happy, thinking that Guoguo was tired from playing during the day and slept so sweetly. But after careful observation, the child's mother found that something was wrong. Little Guoguo not only snored when he slept, but also opened his mouth and couldn't close it. When Guoguo's mother attended a eugenics lecture hosted by the community, she heard the family doctor talk about the disease of "adenoids hypertrophy". She suspected that the child's snoring was also due to this reason. So Guoguo's mother took her son to the hospital's sleep department for examination, and the results confirmed that it was adenoids hypertrophy that was "causing trouble" behind the scenes. After a period of treatment, Guoguo no longer slept with his mouth open, and the snoring sound also stopped abruptly.

What is the "adenoid face"? Director Fu explained in a popular way that adenoids are also called pharyngeal tonsils or adenomas. They are located at the top of the nasopharynx and the posterior wall of the pharynx. They belong to lymphoid tissue and appear "orange-shaped" on the surface. Like tonsils, a person's adenoids gradually grow larger with age. They proliferate vigorously between the ages of 2 and 6, and gradually shrink after the age of 10. Adenoid hypertrophy is a pathological proliferation of the adenoids due to repeated stimulation of inflammation, which in turn leads to symptoms such as upper airway obstruction and oral breathing, especially at night, with reactions such as snoring and restless sleep. Children with the disease cannot sleep well and often turn over. This is more obvious when lying on their backs, and even respiratory arrest occurs in severe cases. This type of apnea refers to partial or complete upper airway obstruction that occurs frequently during children's sleep, seriously interfering with normal ventilation and sleep structure.

Different from the causes of disease in adults, children with enlarged adenoids often have co-existing chronic tonsillitis and tonsil hypertrophy; and it is closely related to factors such as obesity, craniofacial deformities, and neuromuscular diseases. So, what are the clinical manifestations of enlarged adenoids? The first is that young patients breathe with their mouths open for a long time, and are often branded with the unique imprint of "adenoid facies". Dr. Fu Haiwei said that the typical adenoid facies refers to facial development disorders caused by enlarged adenoids, which causes the jaw to become longer, the lip muscles to relax, the lower lip and teeth to be everted, and the base of the nose to become narrower, which does affect the normal appearance to a certain extent. This makes many parents very puzzled and confused, "My baby used to be very good-looking, why is he getting uglier and uglier now?"

Sleep monitoring is helpful in judging the condition, and through oropharyngeal examination, it can be seen that children with enlarged adenoids have a high and narrow hard palate, and sticky secretions can be seen flowing down from the nasopharynx on the posterior pharyngeal wall, often accompanied by hypertrophy of the palatine tonsils; anterior rhinoscopy can be observed with a large amount of secretions in the nasal cavity and swollen mucosa; fiberoptic nasopharyngeal endoscopy can be seen on the top and posterior wall of the nasopharynx, lobed lymphoid tissue with longitudinal fissures can be seen, like half a peeled orange, often blocking the posterior nostril by more than 2/3; lateral nasopharyngeal films can be used to measure the degree of obstruction of the nasopharyngeal airway; nasopharyngeal palpation with fingers can reveal soft lumps on the top and posterior wall of the nasopharynx; CT films can show that the nasopharyngeal air cavity is deformed and narrowed, and the soft tissue of the posterior wall is thickened with uniform density.

How to determine whether children with enlarged adenoids need conservative treatment or surgery? Currently, the only internationally recognized gold standard is polysomnography. Director Fu Haiwei explained that polysomnography, abbreviated as PSG in English, is to wear some examination electrodes when the baby is sleeping, and use a computer to record his breathing dynamics during sleep conditions throughout the night, such as whether there is snoring, apnea, and lack of oxygen? Anyone who snores and holds his breath must undergo a PSG examination to confirm whether it is snoring. In general, mild enlargement of the adenoids in children is usually not a serious threat to their own health, but when the PSG results show that the child is in a state of hypoxic sleep to varying degrees, it means that there is a possibility of physical and intellectual retardation, and even adenoid facies.

Dr. Fu Haiwei suggested that if diagnosed with OSA, the first thing to do is to increase nutrition, prevent colds, improve the body's immunity, and actively prevent and treat the primary disease. After the age of 10, the adenoids will gradually shrink, and the condition may be relieved or completely disappear. Some children often have rhinitis and sinusitis. After proper treatment, nasal ventilation improves and clinical symptoms can be alleviated. If conservative treatment is ineffective, adenoidectomy should be considered as soon as possible.

Treatment plus prevention is expected to achieve twice the result with half the effort. Director Fu introduced that at this stage, the surgical standards recommended by authoritative experts at home and abroad are as follows:

First, it is more appropriate to perform surgical operations on children over 3 years old; second, tonsillitis recurs, that is, the infection occurs at least 7 times within 1 year, or at least 5 times per year for 2 consecutive years, or at least 3 times per year for 3 consecutive years; third, according to the "2020 Chinese Children's OSA Diagnosis and Treatment Guidelines", children with moderate to severe OSA caused by hypertrophy of both adenoids and tonsils are strongly recommended to undergo adenotonsillectomy; fourth, children with enlarged adenoids, accompanied by moderate nasal congestion symptoms, have lasted for at least 1 year, and conservative use of antibiotics and glucocorticoids has not been effective; fifth, because glandular hypertrophy interferes with nasal ventilation and drainage of secretions, and then repeatedly induces rhinitis, sinusitis, purulent or chronic exudative otitis media, asthma and other diseases; sixth, for children with obvious symptoms of adenoids hypertrophy and special facial features, surgery is recommended after oral causes are clearly excluded.

Finally, Director Fu Haiwei reminded parents that when a baby has poor hearing or obviously snores, they should think that the child may not only have problems with the ears or nose, but also go to the hospital in time to check whether there is adenoids hypertrophy; at the same time, they should listen to and watch the weather forecast in time, and add or remove clothes at any time. Children between 2 and 10 years old, especially, should enhance their awareness of prevention, try to avoid repeated colds and symptoms such as runny nose, nasal congestion, coughing, rubbing nose, rubbing eyes, sneezing, etc., to prevent problems before they happen.

Brief Introduction of Director Fu Haiwei

Director of the Sleep Department, Harbin Children's Hospital Affiliated to Harbin Medical University

He is also a member of the Respiratory Sleep Collaboration Group of the Pediatric Branch of the Chinese Medical Association, a member of the Cross-Strait Sleep Professional Committee, a member of the Chinese Sleep Research Society, a standing member of the Children's Sleep Professional Committee of the Three Northeastern Provinces, a deputy director of the Otolaryngology Branch of the Heilongjiang Chronic Disease Society, a deputy director of the Pediatric Branch of the Heilongjiang Chronic Disease Society, a standing member of the Sleep Professional Committee of the Heilongjiang Physician Association, and a standing member of the Otolaryngology Branch of the Heilongjiang Association of Integrated Traditional Chinese and Western Medicine. He is a national second-level psychological counselor.