Home → Research Centres → Nsdc → About Sleep → Children and Sleep

Children and Sleep

Sleep Apnoea in Children

Sleep apnoea in children can be responsible for significant problems including behavioural problems. The parents usually note noisy breathing interrupted by the stopping of breathing. It is often associated with bed-wetting, restless sleeping and sometimes with recurrent awakening through the night.

During the day children tend to have excessive daytime sleepiness. However, in childhood this often manifests itself with over stimulation and hyperactivity. Children can be restless and fidgety with difficulty in maintaining attention. They can show unusual aggressiveness as well as social withdrawal and shyness. This can result in poor school performance and difficulties in learning.

There are many abnormalities of the airway that can be associated with obstructive sleep apnoea in children. However, commonly the presence of large tonsils and adenoids are a correctable cause.

Snoring and Sleep Apnoea in Children

Definitions

Primary Snoring Snoring without hypoxemia or hypercarbia, and no associated sleep disturbance or daytime symptoms.

Sleep Apnoea Partial or complete upper airway obstruction occurring during sleep, usually associated with hypoxemia or hypercarbia, restless sleep and daytime symptoms (nasal obstruction, mouth breathing, mood swings, sleepiness, developmental delay, failure to thrive).

Prevalence

The estimated prevalence of constant snoring in children is approximately 8-9% and of sleep apnoea is 1-2%. Male to female ratio is 1:1 (4:1 in adults).

History and examination are not sufficient to differentiate primary snoring from sleep apnoea. In particular snoring and loudness do not differentiate between the two.

Obstructive Sleep Apnoea can occur without snoring. The parent reporting apnoea, shaking the child and watching the child in fear are factors associated with sleep apnoea.

Reports of sweating during sleep and enuresis are said to be more common in children with obstructive sleep apnoea (based on case reports and case studies).

Excessive Daytime Sleepiness Contrary to adults excessive daytime sleepiness is not common in children with sleep apnoea and when present it should be investigated further with a multiple sleep latency test to exclude other diagnoses such as narcolepsy.

Diagnosis

Diagnosis of disturbed breathing in children is based on the history reported by the parents, examination and overnight polysomnography. Overnight oximetry is used on children but a normal oximetry does not exclude the diagnosis of sleep apnoea.

Treatment

Adenotonsillectomy Adenotonsillectomy is commonly performed for obstructive sleep apnoea and severe primary snoring when adenotonsillar hypertrophy is present. The procedure is performed as an inpatient because of the increased risk of postoperative respiratory complications.

Complications are more common in the young age group (less than two years of age) and patients with severe sleep apnoea, craniofacial malformation and growth delay.

Nasal CPAP Nasal CPAP is successful with use in children however BiPAP (Bilevel Positive Airway Pressure, the pressure increased with inspiration and decreases in expiration) is better tolerated in young patients.

Paediatric sleep studies can be held at The Royal Newcastle hospital and Warners Bay Private Hospital.

It is important that the child is familiarised with the environment before the night of the study with a visit to the unit beforehand.

A parent stays in the same room as the child overnight.