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♪ Hush little baby, don’t say a word… ♪

Years ago people thought nothing really important happened to human beings during sleep. Today sleep medicine allows us to become knowledgeable that during sleep crucial events for life and health occur.

According to a recent study, “children with allergies have a greater risk of suffering from obstructive sleep apnea, a disease which is characterized by diminishing levels of oxygen and leading children to have difficulty breathing during sleep. When this occurs, there is a reduction of oxygen levels which makes children wake up, altering their normal sleep,” said Universidad Nacional de Colombia (UNal) Faculty of Medicine Professor Sonia María Restrepo.

During the research, they sampled 285 children between 0 and 18 years of age and divided into two groups: one with obstructive sleep apnea and a healthy group. They analyzed the changes through a polysomnography, which records brain activity, breathing, and physiological behavior during sleep.

For this, they placed electrodes on the scalp and other places in the body with the purpose of obtaining an electronic record of the brain waves during sleep and wake periods. This procedure helped identify the normal and abnormal sleep patterns and link sleep electric alterations to certain diseases.

The study was carried out at the Sleep Unit of the La Misericordia Hospital with a group of patients of the UNal Respiratory Disease Research Group.

With follow-up provided by Restrepo and epidemiological contributions by Dr. Milena Villamil, both UNal and La Misericordia Hospital Pediatric Pneumologists, they came to the conclusion that “the risk of suffering from obstructive sleep apnea is 1.7 times greater in babies with allergies and living at the altitude of Bogotá.”

During the study they analyzed brain waves, heart rate and breathing patterns to become cognizant if the patients had sleep apnea, a temporary breathing discontinuation or partial obstruction of respiration. They also monitored an electric electromyography of the chin and limbs in order to search for other variables.

“During sleep, there are between 5 and 6 sleeping cycles and two types of sleep, rapid eye movement (REM) and Non-REM. During Non-REM sleep breathing is calm, while in REM sleep breathing is more agitated because the muscles are more relaxed (muscle atonia)”, said Dr. Restrepo.

We all breath while sleeping, however, interrupting respiration, as occurs during sleep apnea may lead to altering some organs and impact behavior with symptoms such as depression, anxiety and low academic achievement in case of children. Some of the reasons for this condition may include facial deformities, obesity, large tonsils, neurological disease or premature birth.

A child suffering from sleep apnea has decreased oxygen levels, especially during REM sleep, making the heart rate increase and in some case making the child to awaken. “Inclusively, children could suffocate and die due to lack of oxygen,” said Dr. Restrepo. Therefore it is important to identify the disease on time.

Signals of infant sleep apnea

It is easier for an adult to say they are tired when they wake up, while a child does not say anything and changes his/her behavior: they can be hyperactive, aggressive or be uptight.

In the last seven years more has been uncovered about children sleep apnea. Before people thought children stopped breathing due to acid reflux. If a mother wants to know if a child has sleep apnea she needs observe how much time it takes for him/her to fall asleep, how much time they sleep, if they make respiratory pauses during sleep, if they snore or what is their position to sleep. She can also observe their daytime behavior if they are hyperactive and even if they have dark circles under their eyes, have a heart problem or be drowsy during the day.

Snoring is unhealthy

The research project also underscores that snoring is not healthy and it is important to assess if a child snores; it may be linked to a respiratory disease; therefore it is mistaken to think that snoring is a sign of a pleasant sleep.

Therefore the researchers suggest parents see a physician if they have doubts over the breathing of a child during sleep and avoid exposing them to substances which may cause allergies.

“We also want to invite parents to avoid exposure to dust mites, moisture, flammable substances, and cigarette smoke. Children should live in healthy, well-ventilated spaces,” they added.

When patients visit a physician they often receive medical prescriptions, so they recommend parents not have fear of drugs for the treatment of these types of conditions.

Two scientific associations highlight the results of the research

The capability of the researchers of verifying with scientific evidence that children who suffer from allergies or live in cities with high altitudes have a greater likelihood of obstructive sleep apnea was acknowledge by pneumologists and sleep medicine specialist communities, a novel field of study in Colombia, with greater background in countries such as the United States and Australia.

During the XIII Congress of Pediatric Pneumology, the Colombian Pediatric Pneumology Association granted first place to one of the studies derived from this research project entitled, “Validation of a sleep pediatric questionnaire in Colombian population” written by María Camila Villalobos Aguirre, Alberto Peña Valenzuela and Sonia María Restrepo Gualteros, of the UNal Medicine Faculty.

Another article recognized was a presentation entitled, “Atopy as a predictor of obstructive sleep apnea in a sample of pediatric patients evaluated a high altitude,” by Sonia Restrepo, Villamil Osorio and Óscar Leonardo Correa Jiménez, of the UNal Medicine Faculty, and Juan Camilo Gélvez of the Universidad del Rosario. The research project was also recognized during the Congress of the Colombian Association of Sleep Medicine this last September.

The judges assessed the rigorous scientific criteria and the size of the sample as which led the study as they reached conclusions with a significant sample: “Children with atopic background of rhinitis, asthma or allergies need to be evaluated to know if they have sleep apnea, even more so if they live in cities such as Bogotá, at more than 2,600 meters (8,530 feet) above sea level. Furthermore, it is also necessary to take into consideration that Colombia for being located in the tropics has environmental conditions which increase the likelihood of suffering from allergic diseases, as opposed to the urban legend that the sole cause of apnea is a malformation or large tonsils,” said Dr. Villamil.

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