Obstructive Sleep Apnea in Children

In a child with Obstructive Sleep Apnea (OSA) the airway is intermittently narrowed or blocked during sleep resulting in pauses of air flow. OSA can have negative effects on a child’s development and overall wellbeing.

How common is OSA in children?  

Approximately 1 to 5 per cent of children have OSA. OSA affects all ages and both genders.  It is most commonly seen in children between the ages of four and six and during adolescence. Risk factors for having OSA include obesity, acquired or hereditary muscle weakness or reduced tone, certain brain disorders, malformations affecting the skull, face and neck structures, history of prematurity, certain genetic syndromes such as Down Syndrome, and a positive family history.

Enlargement of the tonsils and adenoids is the most common cause for OSA in children. The enlarged tonsillar and adenoidal tissue can encroach on the airway narrowing or sometimes obstructing the lumen. Nasal allergies, reflux and sickle cell disease are conditions associated with adenoidal and tonsillar hypertrophy. Not all children with enlarged tonsils and adenoids have OSA.

How do I know if my child has OSA?

Night time signs indicative of OSA in children include snoring, pauses in breathing, gasping, choking, effortful breathing, mouth breathing, restless sleep, frequent awakenings, and bedwetting.

Daytime signs indicative of OSA in children include poor attention and school performance, hyperactivity, moodiness, irritability, excessive daytime sleepiness, fatigue, headache and nasal speech.

What problems can occur with untreated OSA?

Untreated OSA can result in poor school performance due to hyperactivity, daytime sleepiness, moodiness, and poor attention.

On the long term, untreated OSA can increase the risk of developing hypertension, diabetes, and certain cardiac conditions.

How do I find out if my child has OSA?

If OSA is suspected, the first step is to have the child’s healthcare provider perform a history and physical examination looking for indicators of OSA. A video recording of your child’s sleep is helpful.

Diagnosing OSA in children requires performing an in-lab overnight sleep study also known as a polysomnogram or PSG.  During a PSG, the child’s breathing, oxygen levels, CO2 levels, heartbeat, and electrical activity of the brain are recorded. The PSG is performed in a sleep laboratory overnight.

How is obstructive sleep apnea treated in children?    

The treatment depends on a number of factors including the type and severity of the sleep apnea, the child’s age, and the presence of an underlying medical condition.

In the majority of children with significant OSA, adenotonsillectomy surgery is the preferred treatment. Continuous Positive Airway Pressure (CPAP) is a second line of treatment.

What is nasal CPAP?

It is an air compressor that pushes air into a mask that is applied onto the child’s nose during sleep. The CPAP generated air pressure prevents the airway from collapsing during sleep maintaining its patency.

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Contributed by:

Dr. Hisham Hamdan
Consultant, Paediatric Pulmonology and Sleep Medicine at Al Jalila Children’s