Obstructive sleep apnoea is a condition where there is recurrent ‘blockage’ of the upper airway during sleep, leading to reduced airflow to the lungs and sleep disruption.
Snoring is an important symptom of obstructive sleep apnoea, but not all children with snoring will have obstructive sleep apnoea. Children with habitual snoring but no evidence of compromised breathing and sleep disruption have ‘primary snoring’.
It is estimated that overall, three to
12 percent of children have habitual
snoring, and one to three percent of
children have snoring with obstructive
sleep apnoea. Boys and girls are equally
affected. The peak age is between
four to seven years of age, usually in
children with enlarged tonsils and/or
adenoids. There is a second peak seen
in older children above eight years old
who tend to be obese.
Some of the symptoms suggestive of obstructive sleep apnoea include:
Some of the complications of untreated significant obstructive sleep apnoea include:
The two most important causes of obstructive sleep apnoea in children are enlarged tonsils and/or adenoids, and obesity.
Other children at risk for obstructive sleep apnoea include children with neuromuscular (central nervous system and muscle) disorders, abnormalities in the jaw and/or face, Trisomy 21 (Down syndrome), and those with a family history of sleep and breathing disorders.
A clinical history and physical
examination are not sufficiently reliable
to differentiate primary snoring from
obstructive sleep apnoea. If the doctor
suspects that your child has obstructive
sleep apnoea, he will refer your child to
a paediatric sleep specialist for review,
and for an overnight polysomnography
Your child will be admitted overnight
to a single room in a sleep laboratory,
where his/her sleep and breathing
will be monitored and recorded
continuously during sleep.
There will be sensors placed on your
child’s head and body, and elastic
bands placed around his/her chest and abdomen, connected by wires to a
computer system that records the data.
This is not a painful procedure, and
most children will be able to fall asleep,
after they get used to the set-up. A
caregiver is allowed to stay overnight
with the child during the study.
The treatment of obstructive sleep apnoea in children depends on the underlying cause.
In children with enlarged tonsils and/or adenoids, surgery would be recommended.
For more information, please refer to our booklet: ‘Up Close: Get the answers to common Ear, Nose and Throat Conditions’. For more details on surgical treatment, including adenotonsillectomy, please refer to the sections: Common ENT conditions among Children – “Snoring in children”, and “Tonsils and adenoids”.
In children who are obese, weight loss
measures such as healthy eating and
regular exercise are encouraged.
They may also be referred to
paediatric specialists for weight
management programmes and to
screen for conditions such as diabetes,
hypertension and hyperlipidaemia.
In some children where surgery is not
an option, or if they continue to have
significant residual obstructive sleep
apnoea after surgery, they may be
recommended the use of Continuous
Positive Airway Pressure (CPAP)
The CPAP set-up consists of a face
mask connected by a tubing to a
machine that generates and delivers
a positive pressure.
This pressure helps to keep the upper
airway of your child open during sleep.
Children who are treated with CPAP
will need to be managed by a
paediatric sleep specialist, who will
recommend regular follow-up checks
and sleep studies.
Besides the treatments mentioned
above, a small group of children
may benefit from an orthodontic
assessment and other procedures or
surgeries for their sleep apnoea.
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