Snoring and sleep apnoea (OSA) in children

Snoring on its own doesn’t seem to affect children long term and is extremely common. Medical studies show that if your child has sleep apnoea (snoring and breath holding), it can adversely affect their development in the following ways:

The oxygen level in the body falls and prevents restful sleep. Children can often find it difficult to wake up in the morning. They can fall asleep during the day or be tired.

This in turn affects their concentration, learning and behaviour. Not uncommonly this behaviour is put down to a learning problem or ADHD (Attention deficit hyperactivity disorder).

In severe cases it can also affect their growth and heart.

The signs of OSA in children include:

• snoring, often with pauses, snorts, or gasps
• heavy breathing while sleeping
• Night time sweating
• restless sleep and sleeping in unusual positions
• bedwetting
• daytime sleepiness or behaviour problems

Often your GP will be able to provide advice and a referral to an ENT specialist if required. In cases where you or the GP are unsure if there is a problem you can either watch and wait, or ask to see an ENT specialist. Your child may have one or more of the symptoms such as snoring, heavy breathing while sleeping, night time sweating, restless sleep, daytime sleepiness or behaviour problems.

It often helps to record your child’s sleep on your mobile phone to show your doctor. This can reveal characteristic breathing patterns associated with sleep apnoea. 

When we sleep, the muscles in our neck and throat relax. This causes the upper airways to collapse and block off. If severe enough, the oxygen levels in our body drops which is sensed by our brain. This then causes us to wake up ever so slightly allowing the muscles in our neck to stiffen up and open up the airway. We usually do not know when this is happening at night, but we are left with the after effects of a poor sleep as detailed previously.

In children this is usually down to enlarged tonsils and adenoids. Reducing the size of the tonsils and adenoids usually improves the situation. Occasionally there are other factors also to consider which make it more likely that your child has sleep apnoea, including having Down syndrome, problems with the jaw or a large tongue. Rarely, the cause of sleep apnoea is caused by the brain, or so called central apnoea. 

An ENT specialist will be able to work out the best management plan for your child based on the history and clinical examination. Sometimes a sleep study is required to help in the diagnosis.

In many children this will be the case. Your ENT specialist will be able to determine if removing the tonsils and or adenoids will help your child.

The first thing to say is that your child does not need their tonsils or adenoids. See the video link of me here demonstrating the tonsillectomy procedure on BBC’s Operation Ouch! This was taken several years ago and demonstrates a couple of ways of taking the tonsils out.

The procedure can be undertaken in a variety of different ways but in most cases with children, it is better to remove them using the “coblation” technique. This is a relatively new technique and requires suitable training and experience over a lengthy period of time. The rates of bleeding and pain are much less. Recovery and getting back to normal activities is quicker for your child. I first started using this method 10 years ago. During our discussions in clinic, I will talk to you about the different techniques and the pros and cons of them for your child. I will then recommend the technique I think will provide the best result for your child and allow you to decide which you would prefer. 

It is important that you ask your surgeon (whoever you wish to consult), if they offer the coblation technique. If they don’t, they are unlikely to provide you with the full facts. Most paediatric ENT surgeons will use the coblation technique.

Immediately after the operation your child will have a sore throat. This will be controlled with pain killers. They will be encouraged to drink water at first, and then soft foods. Some children might try yoghurt or try ice cream. More solid foods should be tried soon after. Once they are eating and drinking your child will be allowed home the same day. It is unusual for your child to stay in overnight after surgery but can happen if recovery is slower than expected. In certain circumstances, a decision to stay overnight will have been made before surgery if the obstructive sleep apnoea is sufficiently severe.

Antibiotics are not usually required.

If you look at the back of the throat where the tonsils used to be, you will see white slough in the coming days after surgery. This is the normal appearance and does not mean there is an infection. Continuing to eat solid foods helps with removing some of the slough and aids healing. Regular pain killers as directed by my medical team (nurses, anaesthetist and myself) is paramount at least for the first week. If you miss a dose and wait for your child to complain of pain before giving the pain killers they may not be able to swallow the medication. The throat discomfort gets better every day but can increase a little after 4 or 5 days as the nerves heal. Full recovery can take two weeks so allow 2 weeks off school. Often with the coblation technique (see previous link), recovery is much quicker. I usually recommend staying in-doors for the first week. 

In the following two weeks after surgery expect some ear ache which is caused by referred pain from the nerves in the throat which link to the nerves going to the ear. Some streaks of blood in the saliva is normal but if more is seen you will be advised on what to do by the Team. 

Click here to go to the snoring and sleep apnoea information leaflet