Understanding Childhood Sleep Apnoea and Its Effects

A 2024 systematic review of 30 studies estimated that 12.8% to 20.4% of preschool children may suffer from sleep apnoea, although variations in definitions and testing methods make the exact prevalence unclear. Only two studies utilized complete overnight sleep studies, leaving the true figure uncertain.

Parents should be vigilant for warning signs such as habitual loud snoring, mouth breathing, restless sleep, and gasps or snorts. However, not all children who snore have sleep apnoea, and symptoms alone do not confirm the condition.

During the day, children with sleep apnoea may exhibit symptoms that are less obvious, such as irritability, hyperactivity, difficulty concentrating, and learning challenges. These issues can mimic or exacerbate symptoms of attention deficit hyperactivity disorder (ADHD). It is important to note that both conditions can coexist and should not be viewed as mutually exclusive.

Obstructive sleep apnoea occurs when the muscles that keep the upper airway open relax during sleep, causing the airway to narrow or close. This leads to increased effort in breathing, which can decrease blood oxygen levels and disrupt sleep, even if the child does not fully wake.

The effects of disrupted sleep can include poorer behavior, difficulties in learning, and a decline in quality of life. Research also links childhood sleep apnoea with metabolic changes and issues with blood-pressure control, though these effects can vary by child.

In younger children, enlarged tonsils and adenoids are common causes of obstructive sleep apnoea. The tonsils are located at the back of the throat, while adenoids are similar tissues behind the nose; enlarged tissue can obstruct airflow in a child’s narrow airway.

Other risk factors include obesity, anatomical differences in the skull or jaw, and allergic rhinitis. Studies have also found associations with asthma and premature birth. Children with genetic conditions like Down syndrome have a significantly higher prevalence of sleep apnoea. According to research, global obesity rates in 5 to 19-year-olds increased from about 2% in 1990 to roughly 8% in 2022.

Air pollution may also play a role, with observational studies linking fine airborne particles to loud snoring and other breathing issues. However, these studies have not definitively established a causal relationship between pollution and obstructive sleep apnoea.

Children exhibiting frequent loud snoring, periodic pauses or gasps, mouth breathing, or significant difficulty breathing during the night should see a doctor. Initial consultations may lead to referrals to specialists such as paediatricians or ear, nose, and throat experts.

The standard diagnostic test for sleep apnoea is polysomnography or an overnight sleep study. This involves monitoring brain activity, airflow, breathing effort, heart rate, and blood oxygen levels to assess the frequency and severity of breathing interruptions. Preliminary research indicates that video recordings of a child sleeping could assist clinicians in triaging patients, though they cannot replace a formal sleep study.

Treatment varies based on the underlying cause and severity of the condition. Surgery to remove enlarged tonsils and adenoids is often the initial recommendation. In a study involving 464 children, surgery improved symptoms, behavior, and quality of life compared to watchful waiting, though it did not significantly impact cognitive tests measuring attention and behavior control.

Surgery may not be a cure for everyone; up to 40% of children may continue to experience sleep apnoea post-operation, particularly those with obesity or severe conditions. In milder cases, clinicians might suggest monitoring or treating nasal inflammation, although the effectiveness of anti-inflammatory nasal sprays may vary. Mouth and facial exercises sometimes offered lack robust support from larger studies, and evidence for orthodontic devices is also limited.

If surgery is not indicated or if apnoea persists, continuous positive airway pressure (CPAP) can be used to maintain airway patency by delivering pressurized air through a mask during sleep.

While some mild cases may resolve as children grow, others can persist or worsen, making follow-up essential. Regular health checks for children should include a question based on pediatric guidelines: "Does your child snore?" This condition is treatable but often overlooked. Understanding a child’s nighttime behaviors can provide crucial insights into their overall well-being.