Snoring and sleep apnoea
About 15% of children snore, with the commonest cause in this age group being enlarged tonsils and adenoids. Tonsil and adenoid tissue is fleshy tissue that sits at the back of the throat (tonsils) and nose (adenoids). They are part of the immune system (along with lymph nodes in the neck and lingual tonsils on the tongue) that help trap and fight infections. Tonsils and adenoids are typically very small in babies, and get bigger in toddlers and pre -school children. As they enlarge they can cause snoring, which is simply the noise generated by airflow through the throat and upper airway when asleep. In about 2-3% of cases the upper airway can become partially blocked. This can reduce the airflow to the lungs and in severe cases causes the oxygen levels in the body to fall, requiring children to work harder at breathing.
Normal, uninterrupted sleep is important for children. It is important for their general health, but also for brain development and their ability to focus and concentrate the following day. In severe cases sleep apnoea can put undue strain on the heart and lungs.
Sleep apnoea in childhood is frequently due to enlarged tonsils and adenoids. Obesity, craniofacial conditions and some specific genetic conditions can also predispose to sleep apnoea. Occasionally other causes of sleep apnoea are found to account for symptoms of sleep apnoea, such as enlarged turbinates within the nasal cavity , or a floppy voice box. These diagnoses are made during detailed history and examination.
Symptoms and signs that may suggest sleep apnoea include
pauses in breathing when asleep
mouth breathing
poor weight gain
frequently waking during the night
very restless sleep
daytime tiredness
bedwetting
deterioration in behaviour / hyperactivity / poor concentration
Investigations
Often a detailed history and examination is enough to make a diagnosis and commence a treatment plan. In some cases sleep studies will be required to help guide decision making.
Overnight oximetry involves a probe which attaches to your child’s finger or toe and monitors the oxygen levels in the blood and heart rate while they sleep. This test is performed at home and can give an indication of whether your child has sleep apnoea.
Polysomnography and cardiorespiratory sleep studies are more detailed studies of sleep, which may be required if further information about your child’s sleep is needed to make an appropriate management plan. These type of studies not only look at oxygen levels and heart rate, but also monitor effort of breathing, brain activity and limb movements, depending on what type of study is required.
Management
Depending on the outcome from the history, examination and investigations a diagnosis of sleep apnoea may be made and with that an assessment of severity.
Conservative management
Depending on the severity of symptoms and the associated effect on quality of life, adopting a ‘watch and wait’ approach may be the appropriate course of action. A number of children will simply grow out of their symptoms.
Intranasal steroids or treatment of allergy may play a role , if allergy is thought to play a role in the sleep disturbance.
Surgical Management
If enlarged tonsils and adenoids are the cause of sleep apnoea, removal of this tissue may increase the space at the back of the nose and throat and thus make it easier for your child to breathe at night. For more details on this procedure please see the adenoids and tonsils page.
Tips and tricks
keep a sleep diary
video the episodes of sleep disturbance