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Understanding childhood sleep apnoea: symptoms, diagnosis and treatment

A child snoring and sleeping with mouth open on a blanket

October 16th 2023

Put simply, obstructive sleep apnoea (OSA) is a sleep disorder where a blocked or obstructed airway causes difficulties with breathing, and ultimately stops breathing during sleep for short periods. When children have this condition doctors refer to it as paediatric (or pediatric) sleep apnoea.

Newborns and babies aged up to one year can also have infant sleep apnoea, which is usually detected during routine early health checks at hospital or home and has some different symptoms and treatment to those discussed below. If you have any concerns about an infant’s breathing, seek medical advice straightaway.

OSA is the most common form of sleep apnoea1, which we will discuss in this article, but there others that you can read about here.

While the description of OSA may sound a bit scary to parents, it’s important to note that childhood obstructive sleep apnoea is not common (and much less common than it is in adults!), with only around two per cent of children affected2. However, if you’re concerned about your child and want to know more, read on for help and advice.

What is the main cause of sleep apnoea in children? ➜

How can I tell if my child has sleep apnoea? ➜

How serious is sleep apnoea in children? ➜

Does childhood sleep apnoea go away by itself? ➜

Diagnosing childhood sleep apnoea: when to see a doctor ➜

Childhood sleep apnoea treatment ➜

What is the main cause of sleep apnoea in children?

There are actually two main causes of childhood sleep apnoea, which both relate to the physical structure of the neck and throat, which can affect the airways.3,4

 

Enlarged tonsils

If a child has enlarged tonsils (two oval, fleshy masses at the back of the throat) or adenoids (patches of tissue that sit between the top of the nose and the throat), these can block their airways during sleep.

 

Childhood obesity and sleep apnoea

Excess weight can be a cause of sleep apnoea in both children and adults – this because obesity can cause an increase in neck circumference. As a result, throat muscles can become thicker, blocking the airway.

 

Other risk factors for childhood obstructive sleep apnoea

If a child has weakened muscles due to a medical condition such as Down syndrome, cerebral palsy or other neuromuscular diseases, they may also be at a higher risk of sleep apnoea.3,4 Other risk factors for childhood sleep apnoea include:

    • Sickle cell disease5

    • Low infant birth weight6,7

    • Family history of sleep apnoea8-10

    • Structural anomalies of the skull or face11

    • Allergies such as hayfever12

How can I tell if my child has sleep apnoea?

Perhaps the biggest clue is snoring. While many children occasionally snore if they have a cold (just like adults!) only about 10 per cent snore most nights13 – and if a child who is otherwise healthy is regularly snoring loudly, it could be a sign something is amiss…

 

Other symptoms of sleep apnoea in children

Many of the other signs of childhood obstructive sleep apnoea are the same as the symptoms of sleep apnoea in adults.

During sleep14:

  • Tossing and turning and/or sleeping in odd positions
  • Gasping, coughing, snorting or making choking sounds
  • Breathing through the mouth or loudly/unevenly
  • Nightmares
  • Bedwetting (in adults this tends to manifest as needing to go to the loo a lot at night15)

While awake 14:

  • Dry mouth or headache first thing in morning
  • Excessive sleepiness (e.g. falling asleep in class)

How serious is sleep apnoea in children?

While mild sleep apnoea may not have any immediately obvious side effects, in the longer term sleep apnoea can cause health and behavioural problems in children or adolescents.16

 

Childhood sleep apnoea and ADHD

If a child’s sleep is disturbed by sleep apnoea for a long time, they can end up with sustained fatigue and subsequent loss of concentration.17 As a result, they may find it hard to pay attention at school, which can lead to poor performance and learning problems. What’s more, because the behavioural symptoms of childhood sleep apnoea and ADHD (attention deficit hyperactivity disorder) are similar18, OSA can sometimes be misdiagnosed as ADHD.

In severe cases, untreated sleep apnoea can lead to complications such as growth and/or cognitive delays19. And if the condition continues into adulthood it can ultimately result in an increased risk of high blood pressure20, type II diabetes21, stroke22 and heart disease23.

Does childhood sleep apnoea go away by itself?

Having read the above, you may well be hoping the answer to this question is yes! It’s true that some children may ‘grow out’ of their sleep apnoea24, as their airways widen with age or if their tonsils shrink by themselves for example– however since there’s lots that can be done to treat the condition, getting a diagnosis early can help any more serious problems developing over time.

Diagnosing childhood sleep apnoea: when to see a doctor

Many children experience the symptoms listed above as occasional, isolated incidents. However, if your child shows two or more of these signs of sleep apnoea on a regular basis, it may be a good idea to take them for a check-up with your doctor. The same goes for if your child is having trouble sleeping or feels tired even after having seven to eight hours of sleep a night.

Your doctor will give your child a physical examination and ask questions about their symptoms. Then, if they think extra investigation is required, they may refer your child to stay overnight at a sleep clinic for a sleep study.

 

Sleep studies for children

A sleep study helps physicians check for sleep problems or issues with breathing at night. To do this they will monitor a number of your child’s different bodily functions, such as brain activity, heart rate and oxygen levels, as they sleep.

Rest assured that these tests are not painful and the room your child sleeps in at the clinic will be made as comfortable as possible. You’ll also be encouraged to keep your child’s bedtime routine as normal as possible for the visit, so you might like to bring a favourite teddy or blanket and your child’s usual pyjamas etc.

Depending on the clinic, you should be able to stay overnight with your child, either in the same room or nearby – you’ll be told all the details in advance so you can prepare.

Once the test is complete, a sleep specialist will analyse the results to see whether your child has obstructive sleep apnoea, how severe it is, and what course of action to take – this  will be shared with your GP.

Childhood sleep apnoea treatment

Treating OSA in children and young people has been shown to help improve learning, behaviour and quality of life – not to mention the long-term neurodevelopmental25 and cardiovascular benefits26. The treatment that a child receive will depend on the severity and causes of their sleep apnoea.

 

Lifestyle changes

If a child has mild sleep apnoea caused by obesity, then losing weight via lifestyle changes such as eating more healthier and being more active may be enough to rectify the conditions – as well as improving their general wellbeing. Your healthcare provider should be able to support you with these changes.

 

Medication

If an allergy is the cause of or a contributing factor to your child’s sleep apnoea, their doctor may prescribe a course of antihistamines or a steroid nasal spray to see whether this improves matters.

 

Surgery to remove tonsils/adenoids

If a child’s sleep apnoea is caused by enlarged tonsils or adenoids, they may need to have them surgically removed (a tonsillectomy or adenoidectomy). This is usually a straightforward operation carried out under general anaesthetic. Children with sleep apnoea syndrome who have this common treatment have been found to sleep better, be less restless, and report a better quality of life27. However, surgery is not suitable for very young children of those with severe sleep apnoea27.

 

CPAP therapy

If a child is diagnosed with severe sleep apnoea, or a tonsillectomy doesn’t help, their sleep specialist may prescribe continuous positive airway pressure (CPAP) therapy.*

This sleep apnoea therapy works by helping to keep the child’s airways open as they sleep.28 A CPAP machine generates a steady flow of pressurised air, which it delivers to a mask that the child wear while they sleep. A CPAP machine can be used at home, in the child’s usual bedroom.

Although CPAP therapy is more commonly used in adults who have sleep apnoea, your child’s sleep specialist will be able to advise you on things such as finding the right CPAP mask and machine and helping your child adapt to therapy.

 

Tips for helping children get used to CPAP therapy*

Staring CPAP therapy isn’t always easy – for adults let alone children! And it’s natural that such a big change to a child’s bedtime routine might be challenging. Here are some tips that may help.

Start gradually: Try switching on the CPAP device without putting the mask on your child at first so they get familiar with the noise and appearance of the machine.

Be relaxed: Next, you could try letting the device run for about 15 minutes while your child relaxes in bed, before placing the mask on their face ready for sleep.

Practise the process: If your child can’t fall asleep with the mask on, one option is to practise for 15 minutes, then wait until they’re asleep before gently putting the mask on them. You could keep practising each night until your child can fall asleep wearing the mask.

Check on your child: children can pull off their mask during the night (whether unwittingly or on purpose!) so you may need to check on them during the night to make sure it’s still in place – tiring for you but worth it in the long run!

Stay positive:

While treating your child’s sleep apnoea may seem like a daunting journey to embark on, the benefits of treating the condition are well worth it28 and should enable them to live life to the full once more.

 

Read more articles about sleep

Please refer to the user guide for relevant information related to any warnings and precautions to be considered before and during use of the product.

This blog post contains general information about medical conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition, you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website. The views expressed on this blog and website have no relation to those of any academic, hospital, practice, or other institution with which the authors are affiliated and do not directly reflect the views of ResMed or any of its subsidiaries or affiliates.

 

*ResMed CPAP devices are intended for the treatment of obstructive sleep apnoea (OSA) in patients weighing more than 30kg.

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