What is obstructive sleep apnea in children?

Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It happens because of a blockage in the upper airway. This is the passages through the nose and mouth to the windpipe and lungs. The pause in breathing may occur many times in a night, disrupting the child’s sleep. Most children will snore, but other symptoms, such as wetting the bed or sleep walking, may also occur.

The condition is most commonly found in children ages 3 to 6.

What causes obstructive sleep apnea in a child?

The muscles in the head and neck help keep the upper airway open. When a child falls asleep, these muscles tend to relax. That allows tissues to fold closer together. If the airway is partially closed while awake, falling asleep may cause the passage to close completely.

In children, the most common cause for such a blockage is enlarged tonsils and adenoids. These glands are located at the back and to the sides of the throat. They may grow too large. Or an infection may cause them to swell. They may then briefly block the airway during sleep.

Obstructive sleep apnea may also be caused by:

• Being overweight

• A tumor or growth in the airway

• Certain syndromes or birth defects, such as Down syndrome and Pierre-Robin syndrome

What are the symptoms of obstructive sleep apnea in a child?

Symptoms can occur a bit differently in each child. They can include: 

• Loud snoring or noisy breathing (gasping or snorting) during sleep

• Pauses in breathing, lasting usually a few seconds up to a minute

• Mouth breathing

• A nasal voice

• Restlessness during sleep

• Too much daytime sleepiness or irritability

• Hyperactivity during the day

• Behavioral problems

• Sleep walking or night terrors

• Bed wetting

• Need for a nap past the age of napping

• Learning problems

• Morning headaches

The symptoms of obstructive sleep apnea can be like other health conditions. Have your child see their healthcare provider for a diagnosis.

How is obstructive sleep apnea diagnosed in a child?

The healthcare provider will ask about your child’s symptoms, health history, and sleep patterns. They will give your child a physical exam. Your child may also have a sleep study.

A sleep study is the best way to diagnose obstructive sleep apnea. But the test may be hard to do with younger children or those who don’t want to cooperate. For the study, your child may need to sleep in a special lab. While sleeping, they will be connected to monitors that check:

• Brain activity

• Electrical activity of the heart

• Oxygen and often carbon dioxide content in the blood

• Movement of the chest and abdominal wall

• Muscle activity

• Amount of air flowing through the nose and mouth

Your child’s healthcare provider may refer your child to a sleep expert for more evaluation. Sometimes sleep apnea testing may be done with a device used in your own home.

How is obstructive sleep apnea treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The treatment for obstructive sleep apnea is based on the cause. It may include:

• Surgery to remove the enlarged tonsils and adenoids. Your child’s healthcare provider will discuss the risks and benefits with you.

• Weight loss. If your child is overweight, losing weight may ease symptoms.

• Continuous positive airway pressure. While sleeping, your child wears a special mask that delivers a steady stream of air to keep their airway open. Some children may have trouble getting used to the mask.

• Rapid maxillary expansion. This is a device put in place by an orthodontist. The device widens the palate and nasal passages.

• Inhaled or intranasal steroids. These medicines may help children with mild or moderate obstructive sleep apnea caused by enlarged tonsils or adenoids.

• Staying away from secondhand smoke, indoor pollutants, and allergens. This is important for children who also have nasal congestion. Never let people smoke in your home or car.

What are possible complications of obstructive sleep apnea in a child?

Sometimes the condition can cause your child to have less oxygen in the blood than normal. This is because the condition can make it hard for air and oxygen to flow in and out of the lungs. If this pattern continues, your child's lungs and heart may have permanent damage. Chronic sleep apnea can also lead to poor growth and development. Research studies show that some children who are hyperactive, may actually have sleep apnea as the possible cause of their attention-deficit/hyperactivity disorder.

Key points about obstructive sleep apnea in children

• Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It often occurs because of a blockage in the airway.

• The most common cause is large tonsils and adenoids in the upper airway.

• Loud snoring or noisy breathing while sleeping is a main symptom. Your child may also be irritable, sleepy, or hyperactive during the day.

• A sleep study is the best way to diagnose the condition.

• If your child has large tonsils and adenoids, having them surgically removed may help.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.