Obstructive Sleep Apnea Syndrome in Children

Who hasn’t heard the sound of a child softly snoring in their sleep and thought about how cute it sounded? For most children, it is nothing more than that. An estimated 3% and 12% of pre-school aged children snore even though the majority of these children have no other symptoms and appear to be fit and healthy. This type of snoring experienced by children is called primary snoring.

For other children, snoring is not so benign. At least 2% of children have obstructive sleep apnea syndrome (OSAS). OSAS has been identified as a contributing factor to many behavioral problems experienced by children, especially behavioral problems at school. In addition, if left untreated the syndrome can lead to growth, heart and pulmonary problems.

So how do you know if your child is a normal or primary snorer or is suffering from obstructive sleep apnea?

Children who snore but are otherwise well, exhibit normal sleep patterns, and do not exhibit daytime sleepiness are likely primary snorers. A child with OSAS will be restless during sleep, and will experience short pauses, snorts and gasps in breathing while asleep. When awake, they may be sleepy and irritable during the day (because of lack of quality sleep), or hyperactive. These children also tend to have behavioral problems, and a particularly short attention span, which is associated with additional problems at school. Obese children are at a higher risk of having OSAS. It is estimated that between 20% and 40% of obese children suffer from OSAS.

Other symptoms may also be present such as:

• High blood pressure
• Poor weight gain
• Overweight
• Large adenoids and/or tonsils with frequent mouth breathing accompanied by a hyponasal speech (sounds like a sinus cold)

While all children can be affected by OSAS, preschool-aged children seem most susceptible, likely because it is at this age that the adenoids and tonsils that are largest, compared to the airway.

Should you suspect your child has OSAS, your medical practitioner may perform an overnight sleep study (known as a nocturnal polysomnography) to aid in diagnosis. However, since sleep studies such as these tend to be carried out in hospitals in larger cities, you may experience difficulties finding a hospital in your area.

While the polysomnography is the recommended test, your child may undergo further testing, such as video and audio recordings which are then interpreted by a sleep specialist. Pulse and oximetry readings (measurement of oxygen) will also be required while your child sleeps, either at night or during your child’s daytime nap. Although these tests can help to determine whether your child has OSAS, normal results may occur even if your child has OSAS.

If your child is diagnosed with obstructive sleep apnea, treatment options may include the removal of enlarged adenoids and tonsils (the usual cause of the condition). Your child may also have any allergies treated or if necessary, aid in losing weight. Children who are unable to have surgery, or do not improve after surgery, may benefit from CPAP (continuous positive airway pressure) therapy via a nasal mask.

If your child is diagnosed with obstructive sleep apnea, they are likely to be treated by an ear, nose and throat specialist, a pulmonologist or a neurologist. It is important to question your medical team about their experience dealing with children with OSAS, and be an advocate for your child in dealing with these medical professionals. Because tests can sometimes have inconclusive results, you may want to have your child seen by this type of specialist even if your child has tested negative.

While OSAS is only one of many conditions that could be causing your child to snore, it is certainly a serious one, and if you have any concerns, you should consult your doctor for more information.