When Snoring in Children Is a Problem

It is estimated that between 8% and 15% of children snore. The majority of these children are healthy and without other symptoms. However, 1% to 4% of children who snore have obstructive sleep apnea syndrome (OSAS).

How do you know if your child is just a normal snorer or has obstructive sleep apnea? Children who snore and do not have OSAS should be otherwise well, without daytime sleepiness, and should have normal sleep patterns.

In contrast, children with OSAS snore three or more nights per week, and experience sleep that is disrupted by pauses, snorts, or gasps. They may also temporarily stop breathing for several seconds. Children with OSAS also may have behavioral problems, a short attention span, and trouble staying awake or other fatigue-related issues at school.

Other signs or symptoms might include:

• large tonsils and/or adenoids with frequent mouth breathing, hyponasal speech, and nasal obstruction
• poor weight gain
• being overweight
• high blood pressure

If you or your doctor suspects your child has OSAS, testing options include an overnight sleep study (nocturnal polysomnography). Unfortunately, it may be hard to find a hospital or center that does pediatric sleep studies unless you live in a large metropolitan area. As an alternative, your doctor may suggest home sleep apnea testing.

Other testing may include audiotaping or videotaping your child's sleep (bring the tapes to your doctor for help interpreting them), use of overnight pulse oximetry to measure oxygen levels while he sleeps, or just performing a sleep study during a daytime nap. These tests have been shown to be useful in diagnosing OSAS, but a child may still have OSAS even if these results are normal. Further testing may need to be done if you still suspect your child has sleep apnea.

Once it is determined that your child has OSAS, it will be time to discuss treatment options.

First-line treatment will usually include removing enlarged adenoids and tonsils (adenotonsillectomy). Your doctor may also recommend watchful waiting: in a 2013 trial, 46% of children saw their sleep return to normal after seven months while receiving standard care, without surgery. In contrast, 79% of those who had their tonsils removed regained normal sleep patterns. While the children who had surgery saw greater improvements in behavior and quality of life, surgery is not without risk.

Other treatments might include treating a child's allergies and helping overweight children lose weight. You might also try elevating a child's head with pillows during sleep to help ease airways, or having them sleep on their side as opposed to their back or stomach. A night-time treatment known as continuous positive airway pressure (CPAP) therapy with a nasal mask is another treatment option for children who can't have surgery or continue to have obstructive sleep apnea after their adenoids and tonsils are removed.

Doctors who specialize in treating children with OSAS include pediatric otolaryngologists (also called ENT, for ear, nose, and throat, specialists), pulmonologists, and neurologists. If your pediatrician diagnoses your child with obstructive sleep apnea, you will likely need to see one of these doctors. Be sure to find one who has experience treating children with this problem.