Snoring children

Amutha reviewed a paper from Brazil in February’s Paediatric Pearls on children who snore.  I thought it was the kind of problem that would go to GPs but she tells me that a lot of the ED juniors ask her about it as well so presumably parents are seeking information on the cause of their sleepless nights from a number of different sources.

 The paper which talks about obstructive sleep apnoea and the need for ENT referral is downloadable in full from J Otorhinolaryngol. 2010 Oct;76(5):552-6. 

The effects of sleep disturbed breathing during middle- to late-childhood is related to important aspects of behavioral functioning, especially inattention and learning difficulties, that may result in significant functional impairment at school.  Sleep. 2010 Nov 1;33(11):1447-56.  (

3 thoughts on “Snoring children

  1. The rate of OSA in this group (presumably from Brazil) is higher than we would expect in the UK and certainly my referral rate for paediatric sleep studies is no way near this high. From a surgical perspective it is the moderate or significant OSA children that we need to identify as these are the children who may need HDU/prolonged ventilation post-op. The OSA group in this study from Brazil may have included lots of children with mild OSA. If we performed sleep studies on all our children who snore then we may also identify lots of children with mild OSA which is not of clinical significance.

    In terms of asking about apnoeic episodes at night – if you ask a parent whether their child ever stops breathing at night, they will nearly all answer YES as everyone has normal physiological apnoeas. The issue is how long are the apnoeas and how often. To fulfil the basic definition/criteria of OSA the patient has to have cessation of airflow for 10 seconds at a time occurring at least 30 times in a 7 hour period of sleep. When this is explained to parents, the number that then respond YES to apnoeic episodes drops dramatically!

    Most of these children often don’t need surgery as their obstructive symptoms are due to rhinitis which needs medical treatment. If they do not respond to medical treatment then an ENT opinion should be sought.

  2. What’s the rate of adenoid/tonsillectomy by age group, in particular in 3-5yr olds? How long on average do children have symptoms (prior to surgery)? As a GP in waiting I am trying to identify children that don’t meet criteria for moderate OSA but have symptoms like early morning drowsiness, daytime hyperactivity (isn’t that most kids?) that can be reassured +/- medical Rx without referring onwards i.e. without PSG and ‘they will grow out of it’.

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