Children, unrecognized victims of sleep apnea

(AFP) – We speak mainly of adults, but sleep apnea is far from rare in children and harmful to their development, specialists warn, asking for an early diagnosis of this pathology.

Its pediatric prevalence is between 2 and 5% in most studies, sometimes more, stressed pulmonologist-allergist Madiha Ellaffi during a webinar organized on the occasion of the 22nd National Day of Sleep, March 18.

According to Inserm data, the percentage rises to 8% for the 20-44 year olds and more for the elderly. But for this doctor from Albi, co-founder of the Ideas association that promotes the care of young patients, sleep apnea “affects at least one child out of twenty”, a proportion 100 times higher than that of so-called rare diseases.

According to specialists, nocturnal snoring, a clinical sign of a possible obstructive sleep syndrome, is not sufficiently taken into consideration, while a recent survey by the OpinionWay institute, conducted among a thousand parents, highlighted a population of children who snore for 6% .

“I often hear people say: + here she snores like her grandfather + … No, a child who snores is not normal”, assures AFP Patricia Franco, head of the pediatric sleep department at the Donna Madre Bambino Hospital (HFME) in Bron , near Lyon.

There may be occasional discomfort, such as a stuffy nose. “But if the child snores every night, in a prolonged and intense way, we need to think about sleep apnea”, insists the doctor, for whom “this message does not pass enough through the families”.

– Loss of potential –

Often unsuspected in children, this pathology is very harmful, underlines André Stagnara, head of rehabilitation at La Maisonnée, a pediatric follow-up institution located in Francheville (Rhone).

The nocturnal recording of a four-year-old child plays: “a kind of moan” is heard, the air that hardly enters the lungs. Then the sound decreases and the breathing stops for about twenty seconds: an apnea, which is repeated several times an hour.

“He does it all night. However, it is during REM sleep (dream) that we record the learning of the day: the micro-awakenings associated with low oxygenation will alter the child’s psychomotor development, ”summarizes the practitioner. “We cannot imagine the lost potential”.

“To learn to spoon hold, articulate, tie shoelaces, read, write, etc., you need quality sleep, so the brain can do its sorting and filing work,” Doctor Ellaffi abounds. And “to sleep well, you have to breathe well”.

In addition to snoring, restless nights, difficulty waking up, dark circles, pale complexion, tiredness during the day, lack of attention at school, hyperactivity or short temper are other signs and ailments in the child that should encourage parents to consult. .

– Time for diagnosis –

Nasal drops or antiallergic treatment, removal of tonsils or hypertrophic adenoids, oro-maxillofacial physiotherapy to reposition the tongue, surgery of the nasal septum or orthodontics, “continuous positive pressure” self-contained breathing apparatus … The responses to sleep apnea, more or less severe , varies from case to case.

It is still necessary to have access to the diagnosis. In France, there are two baby sleep units, each with three registration beds: in Paris (Robert-Debré hospital) and in Bron (HFME), where the waiting time is “easily one year,” says Patricia Frank.

Since 2019 he has been working on the creation of a regional assistance network to better meet demand. Since 2011 there has been an inter-university degree, with 20 winners per year, and sleep training is developing in pediatrics. The fact remains that specialists are still few.

Services like La Maisonnée also handle registrations, but they are “totally insufficient in number,” he notes.

For André Stagnara, the solution involves the opening of additional beds and the use of remote monitoring of children with hearing aids. The Francheville facility is carrying out a project in this direction, which the Regional Health Authority has agreed to finance for a year of experimentation.

“It makes no sense, the therapist regrets. We have found a pulmonary therapist, which is a godsend, we will not offer her a one-year fixed-term contract …”

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