Many if not most children snore on occasion, and about 10 percent or more snore on most nights. Snoring is a noise that occurs during sleep when the child is breathing in and there is some blockage of air passing through the back of the mouth. The opening and closing of the air passage causes a vibration of the tissues in the throat. The loudness is affected by how much air is passing through and how fast the throat tissue is vibrating. Children who are three years or older tend to snore during the deeper stages of sleep. Primary snoring is defined as snoring that is not associated with more serious problems such as obstructive sleep apnea syndrome (OSAS), frequent arousals from sleep, or inability of the lungs to breathe in sufficient oxygen.
Loud and regular nightly snoring is often abnormal in otherwise healthy children. Sometimes it is a sign of a respiratory infection, a stuffy nose or allergy; other times it may be a symptom of sleep apnea. In 2002, the American Academy of Pediatrics recommended that all children be screened for snoring and that a diagnosis be conducted to determine if a child is experiencing normal primary snoring or obstructive sleep apnea syndrome.
About one to three percent of children not only snore, but also suffer from breathing problems during their sleep. When snoring is accompanied by gasps or pauses in breathing, the child may have OSAS. Children’s muscles normally relax during sleep, but they can become so relaxed that the airway is narrowed or obstructed and sufficient air cannot pass through. This interferes with breathing, causing a pause in breathing that can last only a few seconds or as long as a minute. The brain is then alerted and signals the body to make an effort to start breathing again. This effort results in the child gasping or snorting, waking up and starting to breathe again. Because of these repeated arousals to breathe, the child may not get enough quality sleep and is likely to be sleepy or overtired during the day.
Contributing factors to sleep apnea may be obesity, allergies, asthma, GERD (gastroenterological reflux disorder), an abnormality in the physical structure of the face or jaw as well as medical and neurological conditions. In children, the most common physical problem associated with sleep apnea is large tonsils. Young children’s tonsils are quite large in comparison to the throat, peaking at five to seven years of age. Swollen tonsils can block the airway, making it difficult to breathe and could signify apnea. According to the National Center for Health Statistics, more than 263,000 children in the U.S. have tonsillectomies each year and sleep apnea is a major reason.
Undiagnosed and untreated sleep apnea may contribute to daytime sleepiness and behavioral problems including difficulties at school. In one recent study presented at the American College of Chest Physicians, children who snored loudly were twice as likely to have learning problems. Following a night of poor sleep, children are also more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit/hyperactivity disorder (ADHD). Apnea may also be associated with delayed growth and cardiovascular problems.
During the night, children with sleep apnea may:
- Snore loudly and on a regular basis
- Have pauses, gasps, and snorts and actually stop breathing. The snorts or gasps may waken them and disrupt their sleep.
- Be restless or sleep in abnormal positions with their head in unusual positions.
- Sweat heavily during sleep.
During the day, children with sleep apnea may:
- Have behavioral, school and social problems
- Be difficult to wake up
- Have headaches during the day, but especially in the morning
- Be irritable, agitated, aggressive, and cranky
- Be so sleepy during the day that they actually fall asleep or daydream
- Speak with a nasal voice and breathe regularly through the mouth
If you suspect your child may have symptoms of sleep apnea, talk to your doctor who may refer you to a sleep specialist and/or an overnight sleep study. This study will record the child's sleep, brain waves, body movements, heartbeat, breathing, arousals and noises to determine a diagnosis. Sleep specialists have special training in sleep medicine and can help to determine if your child has primary snoring, sleep apnea or another problem. They can then offer you the most appropriate treatment.
Reviewed by David G. Davila, MD (December 2009).