Paeds · respiratory-sleep-and-airway
Obstructive sleep apnoea in children
Also known as Paediatric OSA · Childhood obstructive sleep apnoea syndrome · OSAS in children · Sleep-disordered breathing in children · Obstructive sleep apnea (paediatric)
Fellowship guide to obstructive sleep apnoea in children: the spectrum of sleep-disordered breathing and the paediatric severity thresholds, why adenotonsillar hypertrophy and obesity narrow the airway, the pathophysiology that links intermittent hypoxaemia and sleep fragmentation to cardiovascular, neurobehavioural and growth morbidity, the bedside assessment and the role of polysomnography and oximetry, adenotonsillectomy as first-line therapy with continuous positive airway pressure and medical adjuncts, and the high-risk populations that change the plan.
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Red flags
- A child with loud habitual snoring plus witnessed apnoeas, gasping or laboured breathing during sleep has obstructive sleep apnoea until a sleep study proves otherwise — never dismiss it as 'just snoring'
- Signs of pulmonary hypertension or right heart strain (a loud P2, hepatomegaly, oedema, an abnormal ECG or echo) in a snoring child indicate long-standing severe OSA and mandate urgent treatment
- A child with severe OSA, very young age, obesity, Down syndrome or a craniofacial or neuromuscular disorder is at high risk of post-adenotonsillectomy respiratory compromise and must have the operation and overnight monitoring in a centre able to manage it
- Failure to thrive with snoring can be OSA — the energy cost of obstructed breathing and disrupted growth-hormone secretion cause poor growth that reverses after effective treatment
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- Obstructive sleep apnoea in children
- Paediatric obstructive sleep apnoea: diagnosis, severity and management
- Sleep-disordered breathing: assessment and adenotonsillectomy
- Short case: the snoring child with adenotonsillar hypertrophy
- Long case: obstructive sleep apnoea in the child with obesity or a syndrome
- Sleep-disordered breathing and obstructive sleep apnoea
- Obstructive sleep apnoea in children: diagnosis and management
- Respiratory: the child who snores
- Pulmonology: obstructive sleep apnea
- Patient Care: obstructive sleep apnea in children
- Medical Expert: paediatric obstructive sleep apnoea
Overview & Definition
Obstructive sleep apnoea in children is a disorder of breathing during sleep in which the upper airway repeatedly narrows or collapses despite continued respiratory effort, disrupting normal ventilation and sleep. The American Academy of Pediatrics frames it as recurrent partial or complete upper-airway obstruction during sleep, associated with disturbed gas exchange and sleep architecture, and it sits at the severe end of a wider spectrum of sleep-disordered breathing that begins with simple snoring. [1] [2]
The clinical importance of the condition is that it is common, it is treatable, and it is easy to dismiss. A child who snores loudly every night is not simply a noisy sleeper; habitual snoring is the entry symptom of a spectrum that can end in cardiovascular strain, growth failure, and measurable harm to daytime behaviour and learning. The examiner's expectation is that a candidate separates benign primary snoring from true obstructive sleep apnoea and knows that the distinction changes the child's trajectory. [4] [9]
References10ShowHide
- [1]Marcus CL; Brooks LJ; Draper KA; Gozal D; Halbower AC; Jones J; et al Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 2012.PMID 22926173
- [2]Marcus CL; Brooks LJ; Draper KA; Gozal D; Halbower AC; Jones J; et al Diagnosis and management of childhood obstructive sleep apnea syndrome (technical report). Pediatrics, 2012.PMID 22926176
- [3]Marcus CL; Moore RH; Rosen CL; Giordani B; Garetz SL; Taylor HG; et al A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med, 2013.PMID 23692173
- [4]Kaditis AG; Alonso Alvarez ML; Boudewyns A; Alexopoulos EI; Ersu R; Joosten K; et al Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J, 2016.PMID 26541535
- [5]Redline S; Tishler PV; Schluchter M; Aylor J; Clark K; Graham G Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med, 1999.PMID 10228121
- [6]Bhattacharjee R; Kheirandish-Gozal L; Spruyt K; Mitchell RB; Promchiarak J; Simakajornboon N; et al Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med, 2010.PMID 20448096
- [7]Brouillette RT; Morielli A; Leimanis A; Waters KA; Luciano R; Ducharme FM Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics, 2000.PMID 10654964
- [8]Chervin RD; Hedger K; Dillon JE; Pituch KJ Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med, 2000.PMID 10733617
- [9]Gozal D Sleep-disordered breathing and school performance in children. Pediatrics, 1998.PMID 9738185
- [10]Marcus CL; Rosen G; Ward SL; Halbower AC; Sterni L; Lutz J; et al Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics, 2006.PMID 16510622