OSA and diagnostic

What causes OSA?

Enlarged tonsils and adenoids are a major contributor to the prevalence of OSA in infants and children, but other factors such as obesity, craniofacial structure, and upper airway muscle tone are important. Long-term nasal obstruction, for example in chronic hay fever,  may also contribute to OSA.

Recent research has linked asthma symptoms in children with snoring and troubled sleep (Pediatrics 2009;124:218-225).

What are the symptoms?

Snoring is usually the first and most obvious symptom of increased upper airway obstruction in sleep, and is extremely frequent in infants and children.  Snoring is an indication that the upper airway has partially collapsed. Other symptoms, as listed by the US National Sleep Foundation, are provided in the table below.

Symptoms of OSA in Infants and Children

During the night, a child with sleep apnea may:

  • Snore loudly and on a regular basis
  • Have pauses, gasps, and snorts and actually stop breathing. The snorts or gasps may wake them and disrupt their sleep.
  • Be restless or sleep in abnormal positions with their head in unusual positions
  • Sweat heavily during sleep

During the day, a child with sleep apnea may:

  • Have behavioural, school and social problems
  • Be difficult to wake up
  • Have headaches during the day, but especially in the morning
  • Be irritable, agitated, aggressive, and cranky
  • Be so sleepy during the day that they actually fall asleep or daydream
  • Speak with a nasal voice and breathe regularly through the mouth

Is OSA detrimental to the child’s health?

According to a recent study in CHEST, the official journal of the American College of Chest Physicians, children who snored loudly were twice as likely to have learning difficulties.  Following a night of poor sleep, children are more likely to be hyperactive and have problems paying attention.  These are also signs of attention deficit/hyperactivity disorder (ADHD).  Interruption of breathing during sleep may also be associated with delayed growth and cardiovascular problems.

The spectrum of disease and morbidity associated with SDB in children is expanding.  As such, degrees of severity (e.g. level of snoring) that might once have been considered clinically irrelevant are now recognised as having substantial developmental, behavioural and other health consequences.

What should I do if I suspect my child has OSA?

The symptoms should be discussed with the child’s paediatrician.

How is it diagnosed?

The diagnosis of OSA in children is usually based on the characteristic symptoms and evidence of adenotonsillar hypertrophy (enlarged tonsils and adenoids) and mouth breathing.  Children suspected of having OSA should usually be evaluated by a Paediatric ENT specialist for further evaluation.

If necessary, further testing might include a sleep study.  In most cases the sleep study must be performed during an overnight stay in a hospital or a specialised sleep clinic.  In some cases, the sleep study may be performed in the child’s home.
During a sleep study, various sensors will be attached to the child to measure sleep quality and breathing patterns.  After the study the results are analysed by a medical professional who will be able to determine if the child has sleep disordered breathing.