Obstructive Sleep Apnea (OSA) in children

What is OSA?

Apnea is when a person stops breathing, and sleep apnea refers to this condition happening mainly during sleep. It most commonly occurs when there is an obstruction or something blocking the upper airway, hence the name obstructive sleep apnea or OSA.

Due to this obstruction during breathing in sleep, the oxygen levels in a child can drop, resulting in the child waking up multiple times and having a restless sleep.

Can children develop OSA?

OSA is common and affects between 1 and 3% of children. The peak age group is 3-6 years (preschool years) which coincides with the growth of adenoids and tonsils. 

OSA is becoming an increasing concern as obesity in children increases and hyperactivity may be related to poor sleeping. Obesity increases the risk of OSA nearly five times. 

Children most likely to have OSA include those who:

  • Snore 
  • Are overweight
  • Have enlarged tonsils and adenoids
  • Have some physical abnormality of the upper airway like genetic syndromes
  • Have facial abnormalities – small jaws, flat faces
  • Have neuromuscular weakness 
  • Have a family member with OSA

When do you suspect OSA in a child?

Children with OSA may have:

  • Frequent loud snoring ( usually parents seek attention ) 
  • Periods of not breathing
  • Mouth breathing 
  • Grunting or snorting noises during sleep
  • Episodes of choking, gasping or awakening
  • Night time sweating
  • Restless and agitated sleep with frequent tossing and turning
  • Unusual sleeping postures (eg.sleeping on the stomach, propped up high on pillows, hyper extended head postures)
  • Excessive day time napping and tiredness
  • Hyperactivity
  • Bed wetting

How is OSA diagnosed?

To diagnose OSA, your doctor will perform a physical exam and take a medical and sleep history. Overnight pulse oximetry (determines oxygen saturation and heart rate) is a screening tool, is not an accurate predictor of OSA. 

The current gold standard for diagnosis of OSA is the overnight polysomnography or more simply called the sleep study. If your child has excessive daytime sleepiness, another test which needs to be conducted is the Multiple Sleep Latency Test (MSLT), on the day after the overnight test.

How is OSA treated?

Treatment varies depending on the cause and severity of OSA. Medications are generally not effective in the treatment of OSA.

  • Weight reduction: Children who are overweight would benefit from weight management programs including nutritional, exercise and behavioral elements. Even a 10% weight reduction can significantly improve obstructive sleep apnea if obesity is the primary cause.
  • Surgery: Children with adenoids and tonsils should be referred for adenotonsillectomy (removal of adenoids and tonsils). This successfully treats OSA in 80-90% of children. This procedure is performed by an ENT doctor under anaesthesia. The surgery is usually approximately 30 minutes and the average hospitalization is for 3 days. The child is often able to consume food soon after the operation.
  • CPAP can be used in patients with persistent OSA despite other treatments. Continuous Positive Airway Pressure (CPAP) is a breathing assistance device which consists of a pump that delivers a continuous flow of air through a mask worn over the nose, helps maintain the airway and aids in comfortable breathing. CPAP restores sleep pattern, relieves airway resistance, enables normal breathing, promotes weight loss and improves h