Sleep Apnea in Children: Signs, Tests and Treatment

01What it is

What obstructive sleep apnea means

Mayo Clinic explains that pediatric obstructive sleep apnea happens when the upper airway narrows or is blocked during sleep, as the muscles at the back of the throat relax. Breathing can briefly stop and start again many times a night. Each time breathing stops, the brain wakes briefly so that the airway can open again, which makes it hard for the child to get enough rest.

The NHLBI notes that sleep apnea can occur at any age, including in babies, and that among children it is most common between ages 2 and 8. Obstructive sleep apnea is the most common type in both children and adults. Our guide on central sleep apnea covers a different type of sleep apnea.

02At night

Nighttime signs beyond snoring

Signs during sleep listed by Mayo Clinic and the NHLBI include:

• snoring
• pauses in breathing, or breathing that starts and stops
• snorting, gasping, coughing or choking
• restless sleep and waking often
• mouth breathing
• night sweating
• bedwetting, especially when it starts after a long period of dry nights

Snoring is common, but not every child who snores has sleep apnea, and not every child with sleep apnea snores. Mayo Clinic notes that infants and young children with obstructive sleep apnea do not always snore and may just have disturbed sleep. Our guide on child snoring explains when snoring needs checking.

03During the day

Daytime attention, behavior and tiredness

During the day, children with sleep apnea might:

• have headaches or a dry mouth in the morning
• breathe through the mouth or have trouble breathing through the nose
• have trouble learning and paying attention, or do poorly at school
• act hyperactive, impulsive or aggressive
• have poor weight gain
• say they feel sleepy, or fall asleep at school or on short car or bus rides

Mayo Clinic explains that adults with sleep apnea usually have daytime sleepiness, while children are more likely to have behavior issues. Behavior and attention problems have many causes, so they do not on their own show that a child has sleep apnea or rule out other conditions such as ADHD; a professional assessment considers the whole picture.

04Risk factors

Tonsils, adenoids and other risk factors

Both sources say the main risk factor in children is having tonsils and adenoids that are larger than usual, especially in younger children. The adenoids are pads of tissue at the back of the nose, and the tonsils are at the back of the mouth. Obesity is also an important risk factor, mainly among teenagers according to Mayo Clinic.

Other factors that raise the risk include Down syndrome and other genetic conditions such as Prader-Willi syndrome, cleft palate or other differences in the shape of the face or skull, neuromuscular disorders, cerebral palsy, sickle cell disease, premature birth or low birth weight, a family history of obstructive sleep apnea and exposure to tobacco smoke. Our guide on adenoids in children explains their role.

05When to see a doctor

When to contact a pediatric professional

Mayo Clinic advises seeing your child’s health care professional if your child has any symptoms of obstructive sleep apnea, including frequent snoring. Online quizzes and rules of thumb can raise awareness, but they cannot diagnose sleep apnea in a child, and adult criteria do not apply to children.

Mayo Clinic stresses that it is important to find and treat pediatric sleep apnea as soon as possible, because early treatment helps prevent complications affecting growth, learning, behavior and heart health. Any child who struggles to breathe, turns blue or is very hard to wake needs urgent medical help.

06Diagnosis

Sleep studies and assessment

The NHLBI explains that diagnosis requires a sleep study, which shows which type of sleep apnea the child has and how serious it is. The health care provider will also look in the nose and mouth for large tonsils or other structures that could block the airway, and may measure blood oxygen levels overnight with a small sensor (pulse oximetry).

Before the appointment, it helps to keep a short record over several nights and days: snoring, pauses or gasps you notice (a short phone video can help), how often the child wakes, bedwetting, morning headaches, daytime sleepiness, behavior and school concerns, and any colds or allergies at the time.

07Treatment

Individual treatment and selected surgery

Treatment depends on the cause. Mayo Clinic says the first treatment may be surgery to remove enlarged tonsils and adenoids, while some children improve with medical devices or medicines. The NHLBI lists surgery to remove the tonsils and adenoids, other surgery to remove tissue from the upper airway, and weight management through diet, exercise and, if needed, behavioral support or a specialist.

The NHLBI also advises keeping children away from secondhand smoke, which can make sleep apnea worse, and working with the child’s health care provider on a plan. Our guides on tonsillectomy and adenoid removal describe these operations.

08Other options

PAP and selected medicines or devices

Depending on the cause, the NHLBI lists other treatments that may be recommended:

• a positive airway pressure (PAP) machine, such as CPAP, which keeps the airway open with air through a mask; the NHLBI notes that long-term use may affect the growth of a child’s face
• steroid nasal sprays
• an asthma medicine of the leukotriene receptor antagonist group, which can cause behavior and mood side effects; contact the child’s provider immediately if you notice any changes
• oral devices or orthodontic treatment
• exercises for the mouth and face muscles (orofacial therapy), guided by a professional

All of these are prescribed and supervised by the child’s care team and chosen for each child; none replaces medical assessment.

09Sources

Where the sources differ

Mayo Clinic and the NHLBI agree on the main signs and risk factors, but they differ in some details:

• Age. The NHLBI says sleep apnea is most common between ages 2 and 8; Mayo Clinic highlights that enlarged tonsils and adenoids matter most in younger children and obesity in teenagers.
• Treatment. Mayo Clinic’s page focuses on symptoms and causes and says surgery may be the first treatment. The NHLBI lists a wider range of options, including PAP, medicines, oral devices and orofacial therapy.
• Complications. The NHLBI lists learning and memory problems, impaired growth, poor school performance and high blood pressure, heart failure or pulmonary hypertension. Mayo Clinic adds high cholesterol and high blood sugar, and notes that very rarely, children with certain genetic conditions can have life-threatening symptoms.
• Medicines. The NHLBI names specific medicines; we mention only the groups.

10Summary

In summary

Obstructive sleep apnea in children causes breathing to stop and start during sleep. Look for snoring, pauses, gasping, restless sleep, mouth breathing and new bedwetting at night, and morning headaches, attention and behavior problems or sleepiness during the day. Enlarged tonsils and adenoids are the main cause, with obesity and some medical conditions also raising the risk.

A sleep study confirms the diagnosis. Treatment is chosen for each child and may include removing the tonsils and adenoids, weight management, PAP, medicines or devices. Surgery does not always resolve the problem completely, so follow-up matters: if symptoms continue after treatment, talk to the child’s provider about other options.