What is obstructive sleep apnea in children
Obstructive sleep apnea syndrome (OSAS) in children is a respiratory disorder in which the upper airways become partially or completely blocked repeatedly during sleep. This obstruction causes breathing pauses (apneas), hypopneas (reduced airflow), and blood oxygen desaturations.
In children, the most common cause is adenoid hypertrophy and palatine tonsil enlargement. The prevalence is estimated at 1-5% of the pediatric population, with a peak incidence between 2 and 8 years of age.
Causes and risk factors
The main cause of OSAS in children is adenotonsillar hypertrophy — enlarged adenoids and tonsils physically obstruct the airway during sleep, when the pharyngeal musculature is relaxed.
Other contributing factors include:
- Chronic nasal obstruction — septal deviation, allergic rhinitis, nasal polyps
- Obesity — peripharyngeal adipose tissue deposition
- Craniofacial anomalies — micrognathia, retrognathia, Pierre Robin syndrome
- Neuromuscular diseases — generalized muscular hypotonia
- Down syndrome — combination of macroglossia, hypotonia, and particular craniofacial anatomy
- Residual laryngomalacia
Symptoms
OSAS symptoms in children manifest both during sleep and throughout the day:
Nighttime symptoms
- Regular, loud snoring (present on most nights)
- Breathing pauses observed by parents
- Mouth breathing during sleep
- Restless sleep with frequent position changes
- Excessive night sweating
- Neck hyperextension during sleep (to open the airway)
- Nocturnal enuresis (especially in children who were already dry at night)
Daytime symptoms
- Predominantly oral breathing
- Morning fatigue, difficulty waking up
- Attention and concentration difficulties (often confused with ADHD)
- Paradoxical hyperactivity
- Behavioral problems and irritability
- Growth and developmental delay (in severe cases)
Diagnosis
Diagnosing OSAS in children involves several steps:
- Detailed medical history — history of snoring, observed apneas, sleep quality
- Complete ENT examination — evaluation of the tonsils, nasal endoscopy for assessment of adenoid hypertrophy
- Polysomnography (PSG) — the gold standard: overnight recording of respiratory, cardiac, and neurological parameters during sleep
- Respiratory polygraphy — a simplified alternative to PSG
- Nocturnal pulse oximetry — first-line screening, measures oxygen saturation throughout the night
Treatment
Surgical treatment
The first-line treatment for pediatric OSAS with adenotonsillar hypertrophy is adenoidectomy combined with tonsillectomy (adenotonsillectomy). The success rate is approximately 80% in children without obesity or comorbidities.
Conservative treatment
- Nasal corticosteroids — can reduce adenoid volume by 20-30%
- Leukotriene receptor antagonists (montelukast) — local anti-inflammatory effect
- Treatment of associated allergic rhinitis
- Weight loss (in obese children)
CPAP/BiPAP
Continuous positive airway pressure (CPAP) ventilation is used in cases where surgery is not indicated or apnea persists postoperatively.
When to see a doctor
Consult an ENT specialist if:
- Your child snores regularly (more than 3 nights per week)
- You observe breathing pauses during sleep
- Your child constantly breathes through the mouth
- There are unexplained concentration problems or hyperactivity
- Your child wakes up tired despite a sufficient number of hours of sleep
Suspect obstructive sleep apnea in children? Schedule a consultation for diagnosis and a personalized treatment plan.