Paediatric sleep apnea a growing concern

Three-year-old Zuri Crawford used to have many restless nights, recurring colds, and even bouts of breathlessness during her earlier years.

When she frequently suffered from sleep apnea, her mother, Nicole Phillips-Crawford, a young professional in her early 30s, says the experience drained her emotionally and financially.

At times, Phillips-Crawford only remembers feeling terrified.

“She would snore … and after that she stopped breathing,” Phillips-Crawford recalled. “We had the steroid on standby … it would wake her up enough to ... rush to the hospital.”

With these constant and late night emergencies, Phillips-Crawford, her husband Chad Crawford and their two children became a sleepless family.

Zuri’s case is far from isolated. Dr Marsha James, ear, nose and throat (ENT) specialist and consultant at the Bustamante Hospital for Children, says paediatric sleep apnea is a growing concern in Jamaica and often goes undiagnosed.

“Sleep apnea is a sleeping disorder during which there are periods of no breathing, usually lasting more than 10 seconds during sleep,” James told The Gleaner. “In children, parents will notice that they have heavy snoring, mouth breathing and then they’ll notice that period of no breathing and then they may wake up from sleep gasping.”

According to James, this condition, particularly obstructive sleep apnea (OSA), is commonly caused by enlarged adenoids and tonsils in children between ages four to six. But some cases can appear earlier. “We have seen some patients presenting as early as two years,” she said, noting that common signs include snoring, mouth breathing, nasal congestion, and restless sleep.

While not as common as OSA and rather than a blockage of the airway, central sleep apnea (CSA) occurs when the brain fails to send proper signals to the muscles that control breathing.

According to James, patients who have neurological problems, such as cerebral palsy, are treated by a neurologist and often benefit from Continuous Positive Airway Pressure (CPAP).

LACK OF SOLID NATIONAL DATA

James estimates that about 10 per cent of children who present to the ENT clinic at Bustamante Hospital show symptoms of sleep apnea. However, she cautions that Jamaica lacks solid national data on the condition’s prevalence.

For Phillips-Crawford, the journey toward understanding her daughter’s condition was filled with frustration and fear.

“From about one-year-old, we noticed that she snored a lot … and she just had a lot of colds and upper respiratory infections. Every month we were at the paediatrician,” she shared.

After a series of referrals, the Crawfords were finally seen by James, who diagnosed Zuri with enlarged tonsils and adenoids, a textbook case of obstructive sleep apnea.

“From the first visit, she said to us, ‘She needs surgery’,” Phillips-Crawford said.

Zuri’s condition worsened to the point where she was prescribed a steroid to use in emergency situations to jolt her out of apneic episodes.

“We had to be using the oximeter to monitor the oxygen levels … especially when she had an infection,” Phillips-Crawford said. “You don’t want to be the parent responsible to say you were sleeping and your child slept away and didn’t wake up.”

Beyond sleepless nights, untreated sleep apnea can significantly affect a child’s development. James warns that it can cause learning and behavioural disorders, including hyperactivity and daytime sleepiness.

“These patients can go on to have poor brain development and therefore have problems with learning,” she said. “There is also … the risk of cardiovascular complications, so heart problems including right heart failure and pulmonary hypertension.”

In Zuri’s case, Phillips-Crawford began to connect the dots between her daughter’s sleep issues and behavioural concerns.

“She would be seen as almost disruptive,” she said. “Since the surgery … the hyperactivity sort of slowed down, the speech became clearer, the sleep improved.”

While surgeries such as the adenoidectomy (removal of the adenoids) and tonsillectomy (removal of tonsils), is the standard treatment for obstructive sleep apnea, it is not always easily accessible.

According to James, these procedures are available at Bustamante Hospital, Cornwall Regional, Mandeville Regional, and semi-privately at the University Hospital of the West Indies. However, the wait times can stretch to three months, with priority given to urgent cases.

James noted that Jamaica’s lack of sleep study equipment, called polysomnography, means most diagnoses are made clinically.

“The gold standard of diagnosis is a sleep study … (but) we rely on our clinical features, sometimes supported by X-rays,” she said. “And they’re usually done by pulmonologists, most of whom are not equipped or comfortable with younger patients.”

ACCESS TO PRIVATE CARE

Phillips-Crawford considers herself fortunate to have had the means to access private care, especially during the early stages at least. Although slightly difficult, Zuri’s first consultation, she says was secured after two years at a private paediatric facility at the time.

However, not every parent is as lucky as Phillips-Crawford as one mother, she said, must leave from out-of-parish for treatment at Bustamante due to lack of resources at their local hospitals.

“She leaves St Ann because no longer could the St Ann’s Bay Hospital deal with her son’s issues … she leaves home like three in the morning … and they end up leaving at four or five in the afternoon.”

Now that her daughter Zuri has undergone successful surgery and her eight-month-old son Zane is being closely monitored for similar issues, Phillips-Crawford is determined to spread awareness.

“You have to be intentional,” she advised. “In terms of even the home, you have to do a little more … clean your fans once or twice a week … stay away from strong scents, processed foods, dust, plush toys.”

She also urged other parents to remain consistent with prescribed medications and to seek out paediatric ENT care, especially at Bustamante if private care is unaffordable.

“We could also educate children as well as their families and parents to recognise these symptoms,” James said, advocating for more public awareness.

“We can conduct studies to confirm the prevalence … and do health promotion and education at the level of early childhood daycare, through media, and within the health system at large.”

As Phillips-Crawford reflects on her family’s journey, she is thankful that she advocated for answers.

“Since surgery has happened, we haven’t had a single episode of cold or flu. And I mean, every two weeks we used to have something happening.”

After recalling one of Zuri’s most challenging episodes, where she required antibiotics every four hours, Phillips-Crawford said she was simply grateful that those tougher days are now behind them.

mickalia.kington@gleanerjm.com