A disorder that causes seemingly healthy infants to stop breathing while they sleep is called—

• it's not normal for children to snore
• snoring or noisy breathing may mean your child has obstructive sleep apnoea (OSA)
• OSA is a medical condition - narrowed breathing passages make breathing more difficult during sleep
• snoring can have long-term effects on sleep quality, behaviour and learning
• enlarged tonsils and adenoids are an important cause of OSA, and an operation to remove them can fix the problem
• overweight children are at greater risk of OSA

It is normal for children to sometimes make noises with breathing during sleep. It's not normal for children to snore unless they are unwell with a cold.

Noisy breathing can come from the nose or from an open mouth. It can be worse when your child is sleeping on their back. If you notice snoring or noisy breathing often during your child's sleep, talk to your family doctor. It might be a sign of a condition called obstructive sleep apnoea (OSA).

What is obstructive sleep apnoea?

Narrowed breathing passages make breathing more difficult during sleep

When someone falls asleep, the muscles of the throat relax and the breathing passages at the back of the nose and in the throat become narrower. In children, the tonsils and adenoids can grow to be quite large, and less air gets through the breathing passages during sleep. When this happens, you may notice snoring or noisy breathing.

Snoring is more common during some phases of sleep

There are some times during sleep when the muscles are more relaxed. Snoring is more common during these phases of sleep. This is why snoring can be more common in the second half of the night.

Snoring needs checking

Snoring is not always a very serious problem for children - about 15 to 20 in 100 children snore. But, it is a symptom that needs checking by your family doctor as 2 to 5 in 100 children have OSA.

Reasons for OSA

In children, the most common reason for OSA is enlarged tonsils and adenoids. In older children and teens, being overweight is a common reason. Any medical condition that affects the size and shape of your child's breathing passages can also make OSA more likely.

The photo below shows enlarged tonsils in a child who has OSA.

What problems can obstuctive sleep apnoea cause?

In OSA, the narrowing of the breathing passages at the back of the nose and in the throat during sleep is enough to cause breathing difficulty or pauses in breathing. A child wakes up briefly because they cannot breathe properly, often with a loud gasp or snort. These episodes can happen many times through the night and the disturbed sleep can result in changes in behaviour during the day such as:

• poor attention and lack of concentration
• hyperactive behaviour
• seeming 'fragile' or 'oversensitive' or 'overtired' or 'grumpy'
• being impulsive (tending to act without thinking)
• difficulty learning at school because of issues with concentration
• sleepiness (but this is more common in teens and adults than children)

Severe OSA can cause high blood pressure and put strain on the heart. This is not as common in children as in adults but it is something your doctor will look for.

How can I tell if my child might have obstructive sleep apnoea?

Signs of possible OSA in a child who snores include:

• restlessness during sleep (moving around the bed a lot)
• short pauses in breathing - the chest is moving but no air is moving through the nose and mouth
• needing to make more effort to breathe
• sweating during sleep
• mouth breathing when asleep or awake - the passage to the nose may be completely blocked
• daytime behaviour issues (see the section above)

Watch a video of a child with severe OSA. You can see his chest sucking in with each breath. The noises you can hear are because his breathing passages are partly blocked.

What should I do if I think my child has obstructive sleep apnoea?

If you are worried that your child may have OSA, take them to your family doctor. Your doctor will examine your child and may recommend your child sees either:

• an ear, nose and throat surgeon if your doctor thinks the tonsils and adenoids are causing the problem
• a paediatrician (a doctor who treats children)

The doctor will want to know all about your child's sleep patterns. They will examine your child's breathing passages by looking into their mouth and nose. It can be very helpful for you take a video (on your phone) of your child sleeping. Try to film the breathing pattern you are most concerned about so that you can show this to your doctor.

Your child may not need any further investigations if it's clear your child has OSA.

For some children, the doctor may recommend your child has an overnight oximetry test or a sleep test (polysomnography).

Read more about oximetry

Read more about polysomnography

What is the treatment for obstructive sleep apnoea?

The treatment for OSA depends on its cause. The most common treatment is removing the tonsils or adenoids (or both tonsils and adenoids) to open up the breathing passages.

Children who have this surgery need to go back to the doctor 6 to 8 weeks after their surgery. The doctor will check that their symptoms are better.

Read more about tonsillectomy and adenotonsillectomy

Removing tonsils or adenoids (or both) can fix OSA. Some children keep having symptoms after surgery. This is more common in overweight children.

If surgery is not recommended for your child, or if your child keeps having symptoms after removal of their tonsils or adenoids (or both), they may need further tests. They might need an overnight oximetry test or a sleep test (polysomnography). See the links to information about oximetry and sleep tests (polysomnography) in the section above.

Some children will need further treatment such as:

• a weight management programme
• treatment to help with breathing during sleep - such as CPAP (continuous positive airway pressure)
• more surgery

Read more about CPAP (continuous positive airway pressure)

See more KidsHealth content on sleep

Check all KidsHealth's content on sleep

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It happens because of a blockage in the upper airway. This is the passages through the nose and mouth to the windpipe and lungs. The pause in breathing may occur many times in a night, disrupting the child’s sleep. Most children will snore, but other symptoms such as wetting the bed or sleep walking may also occur.

The condition is most commonly found in children ages 3 to 6.

The muscles in the head and neck help keep the upper airway open. When a child falls asleep, these muscles tend to relax. That allows tissues to fold closer together. If the airway is partially closed while awake, falling asleep may cause the passage to close completely.

In children, the most common cause for such a blockage is enlarged tonsils and adenoids. These glands are located at the back and to the sides of the throat. They may grow too large. Or an infection may cause them to swell. They may then briefly block the airway during sleep.

Obstructive sleep apnea may also be caused by:

• Being overweight
• A tumor or growth in the airway
• Certain syndromes or birth defects, such as Down syndrome and Pierre-Robin syndrome

Symptoms can occur a bit differently in each child. They can include: 

• Loud snoring or noisy breathing (gasping or snorting) during sleep
• Pauses in breathing, lasting usually a few seconds up to a minute
• Mouth breathing
• A nasal voice
• Restlessness during sleep
• Too much daytime sleepiness or irritability
• Hyperactivity during the day
• Behavioral problems
• Sleep walking or night terrors
• Bed wetting
• Need for a nap past the age of napping
• Learning problems
• Morning headaches

The symptoms of obstructive sleep apnea can be like other health conditions. Have your child see his or her healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms, health history, and sleep patterns. He or she will give your child a physical exam. Your child may also have a sleep study.

A sleep study is the best way to diagnose obstructive sleep apnea. But the test may be hard to do with younger children or those who don’t want to cooperate. For the study, your child may need to sleep in a special lab. While sleeping, he or she will be connected to monitors that check:

• Brain activity
• Electrical activity of the heart
• Oxygen and often carbon dioxide content in the blood
• Movement of the chest and abdominal wall
• Muscle activity
• Amount of air flowing through the nose and mouth

Your child’s healthcare provider may refer your child to a sleep expert for more evaluation. Sometimes sleep apnea testing may be done with a device used in your own home.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The treatment for obstructive sleep apnea is based on the cause. It may include:

• Surgery to remove the enlarged tonsils and adenoids. Your child’s healthcare provider will discuss the risks and benefits with you.
• Weight loss. If your child is overweight, losing weight may ease symptoms.
• Continuous positive airway pressure (CPAP). While sleeping, your child wears a special mask that delivers a steady stream of air to keep his or her airway open. Some children may have trouble getting used to the mask.
• Rapid maxillary expansion. This is a device put in place by an orthodontist. The device widens the palate and nasal passages.
• Inhaled steroids. These medicines may help children with mild or moderate obstructive sleep apnea caused by enlarged tonsils.
• Staying away from secondhand smoke, indoor pollutants, and allergens. This is important for children who also have nasal congestion.

Sometimes the condition can cause your child to have less oxygen in the blood than normal. This is because the condition can make it hard for air and oxygen to flow in and out of the lungs. If this pattern continues, your child's lungs and heart may have permanent damage. Chronic sleep apnea can also lead to poor growth and development.

Key points about obstructive sleep apnea in children

• Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It often occurs because of a blockage in the airway.
• The most common cause is large tonsils and adenoids in the upper airway.
• Loud snoring or noisy breathing while sleeping is a main symptom. Your child may also be irritable, sleepy, or hyperactive during the day.
• A sleep study is the best way to diagnose the condition.
• If your child has large tonsils and adenoids, having them surgically removed may help.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.