Sleep apnea | Children, unrecognized victims

(Lyon) It is mentioned above all for adults, but sleep apnea is far from rare in children and harmful to their development, warn specialists, calling for early detection of this pathology.

Posted at 10:29

Pierre PRATABUY
France Media Agency

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

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

Nocturnal snoring, a clinical sign of a possible obstructive sleep syndrome, is insufficiently taken into account according to specialists, while a recent survey by the OpinionWay institute, carried out among a thousand parents, revealed a population 6% of snoring children.

“Often I hear people say: ‘Hey, he snores like his grandfather’… No, a child who snores is not normal”, assures AFP Patricia Franco, head of the pediatric sleep unit. at the Woman Mother Child Hospital (HFME) in Bron, near Lyon.

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

Loss of potential

Often unsuspected in children, this pathology is very harmful, points out André Stagnara, rehabilitation manager at La Maisonnée, a pediatric follow-up care establishment located in Francheville.

He plays the nocturnal recording of a 4-year-old child: we hear “a kind of banging”, the air entering the lungs with difficulty. Then the sound decreases and breathing stops for about twenty seconds: an apnea, which is repeated several times per hour.

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

“To learn how to hold your spoon well, articulate, tie your shoelaces, read, write, etc., you need quality sleep, so that the brain can do its job of sorting and archiving”, abounds the Dr Elaffi. And “to sleep well, you have to breathe well. »

Besides snoring, restless nights, difficulty waking up, dark circles in the eyes, pale complexion, fatigue during the day, lack of attention at school, hyperactivity or irascibility are other signs and disorders, in the child, which must encourage the parents to consult, plead the specialists.

Time to diagnosis

Nose drops or antiallergic treatment, removal of tonsils or hypertrophied adenoids, oro-maxillofacial physiotherapy to reposition the tongue, nasal septum surgery or orthodontics, “continuous positive pressure” breathing apparatus… Responses to sleep apnea , more or less heavy, vary depending on the case.

It is still necessary to have access to the diagnosis. Two children’s sleep units, each with three registration beds, exist in France: in Paris (Robert-Debré hospital) and in Bron (HFME), where the waiting time reaches “easily a year”, says Patricia Frank.

Since 2019, she has been working on the creation of a regional care network to better meet demand. An inter-university diploma has existed since 2011, with 20 winners per year, and sleep training is developing in paediatrics. The fact remains that specialists are still few in number.

Services like La Maisonnée also manage recordings, but they are “totally insufficient in number”, it is pointed out.

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

“It makes no sense,” laments the practitioner. We found a pneumopediatrician, which is a godsend, we are not going to offer her a one-year fixed-term contract…”

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