Obstructive sleep apnoea

Obstructive sleep apnoea

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Key points to remember

  • obstructive sleep apnoea is a narrowing of the airways at the back of the nose and in the throat during sleep that causes a child to have difficulty breathing and pauses in their breathing 
  • the effect on a child can include disturbed sleep, poor daytime behaviour and difficulty learning at school
  • enlarged tonsils and adenoids are an important cause of obstructive sleep apnoea, and an operation to remove them can resolve the problem
  • overweight and obese children are at greater risk

What is obstructive sleep apnoea?

Enlarged tonsilss
Enlarged tonsils in child with obstructive sleep apnoea. See Acknowledgements for this photo.
 
 
When someone falls asleep, the muscles of the throat relax and the airways at the back of the nose and in the throat become narrower. This can cause snoring or noisy breathing. Although noisy breathing during sleep is common in children, it may be a sign that the child is having difficulty breathing. In young children, the tonsils and adenoids may grow to be quite large, and this can contribute to narrowing of the airway during sleep. 
 
Obstructive sleep apnoea is a condition where narrowing of the airways at the back of the nose and in the throat during sleep is enough to cause a child to have difficulty breathing or pauses in their breathing. The child will then wake up briefly because they cannot breathe properly, often with a loud gasp or snort. These episodes can happen many times through the night and the disturbed sleep can result in changes in behaviour during the day such as sleepiness, hyperactive behaviour, impulsivity, poor attention and difficulty learning at school.

How can I tell if my child might have obstructive sleep apnoea?

Snoring or noisy breathing is common in children but may also be the first sign of obstructive sleep apnoea.
 
Other signs of possible sleep apnoea in a child that snores include:
  • being overweight or obese as these children are at greater risk than children of normal weight
  • restlessness during sleep (moving around the bed a lot)
  • short pauses in breathing - although the chest is moving, no air is moving through the nose and mouth
  • mouth breathing when asleep or awake - the passage to the nose may be completely blocked
  • daytime sleepiness or irritability (because the quality of sleep is poor)
  • hyperactivity during the day

What should I do if I think my child might have obstructive sleep apnoea?

If you are worried that your child may have obstructive sleep apnoea, take them to your family doctor. Your doctor will examine your child and will refer them to an ear, nose and throat surgeon if their tonsils and adenoids are thought to be causing the problem, or to a paediatrician for further investigations. The doctor will want to know all about your child’s sleep patterns and will examine the airway by looking into their mouth. A paediatrician may refer your child for a polysomnography or sleep study.
 
See the Polysomnography fact sheet on this website.
 

How is obstructive sleep apnoea treated?

The treatment for obstructive sleep apnoea depends on what is causing it. The most common treatment is removing the adenoids and tonsils to open up the airway. 
 
See the Tonsillectomy and adenotonsillectomy fact sheet on this website.
 
If your child is overweight or obese, your doctor can provide advice about healthy eating and exercise, or refer your child to a special group to help them lose weight, or refer them to a paediatrician for more tests. 
 
If your child still has obstructive sleep apnoea after the adenoids and tonsils are removed, your doctor may suggest treatment with a special mask that your child wears while asleep. This treatment is called CPAP (continuous positive airway pressure).
 
See the CPAP (continuous positive airway pressure) fact sheet on this website.
 

Where to go for more information

On this website
 
SAANZ (Sleep Apnoea Association of New Zealand Inc.)
SAANZ is a national support group (for adults and children) which aims to promote awareness of sleep apnoea and sleep disorders. Their website provides a fact sheet on childhood snoring and sleep apnoea.
 
Paediatric Society of New Zealand
A 52-page guideline at the Paediatric Society website is aimed at health professionals but may be of interest to those parents who want more detailed information on sleep apnoea:
Australian website
 
Royal Children's Hospital, Melbourne
The Royal Children's Hospital website provides access to a fact sheet on Childhood obstructive sleep apnoea (OSA).
 
International website
 
Kidshealth website (Nemours Foundation, United States)
The Nemours Foundation website provides a Sleep apnea fact sheet, which includes information about different types of sleep apnoea. Please note that as this is written for an American audience, it refers to the US emergency number. The NZ emergency number is 111.
 

Acknowledgements

Photos
Thank you to Dr Murali Mahadevan for providing the photo of enlarged tonsils from his personal collection. 
 

Content endorsed by the Paediatric Society of New Zealand 19 May 2010
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2013
Printed on 25 May 2013. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version

DISCLAIMERThis fact sheet is for educational use only.
Please consult your doctor or other health professional to make sure this information is right for your child.