Sleep-Disordered Breathing and Sleep Apnoea in Children
Sleep-disordered breathing is a term used for abnormal breathing during sleep. It ranges from persistent snoring and noisy breathing through to obstructive sleep apnoea, where the airway becomes partly or completely blocked during sleep.
When we fall asleep, the muscles of the throat naturally relax. In most children, the airway stays open without difficulty. However, if a child has large tonsils and/or adenoids, that normal relaxation can allow the airway to narrow or become blocked. As a result, breathing may become noisy, laboured, or interrupted during sleep.
At the milder end, this may cause snoring or restless sleep. At the more severe end, it can lead to pauses in breathing, repeated disruption of sleep, and dips in oxygen levels. In children, the commonest cause is enlarged tonsils and/or adenoids.
In many children, the problem improves as they grow, particularly as the airway develops and the relative size of the tonsils and adenoids becomes less significant. Even so, we do not simply ignore it, because poor-quality breathing during sleep can affect behaviour, concentration, mood, daytime energy, school performance, and overall quality of life. In more significant cases, treatment is important to reduce the impact of low oxygen levels during sleep.
What symptoms suggest sleep-disordered breathing?
Children with sleep-disordered breathing may have:
loud or regular snoring
restless sleep
pauses in breathing
gasping, choking, or snorting noises during sleep
mouth breathing
disturbed sleep or frequent waking
daytime tiredness
irritability, poor concentration, or behavioural change
Why does it happen?
In children, the most common cause is enlargement of the tonsils, the adenoids, or both. These tissues can narrow the airway during sleep, particularly when the throat muscles relax. Weight can also contribute in some children, and certain conditions can increase risk, including Down syndrome and craniofacial or neuromuscular problems.
Very occasionally, sleep apnoea may be due to a more central cause, where the problem is not mainly obstruction from the tonsils or adenoids. This is rare, but it is one reason why not every child with sleep-related breathing symptoms is automatically best treated with surgery.
Why do we treat it if many children grow out of it?
It is true that many children improve over time. Simple snoring can settle as a child grows, and the adenoids tend to shrink with age. However, treatment is considered when the breathing problem is affecting sleep quality, daytime functioning, or overall wellbeing, or when there is more convincing evidence of obstructive sleep apnoea rather than just simple snoring.
The reason for treatment is not simply the noise at night. The concern is the effect that repeated airway obstruction can have on sleep quality, oxygen levels, daytime behaviour, concentration, mood, and quality of life.
How is it treated?
Treatment depends on the cause and severity of the problem.
In many children with significant sleep-disordered breathing caused by enlarged tonsils and/or adenoids, the usual treatment is tonsillectomy, adenoidectomy, or both together. In milder cases, careful observation may sometimes be appropriate, particularly if symptoms are not severe and the child is otherwise well. In some children, treatment of nasal blockage, allergy, or weight-related factors may also form part of the overall plan.
Very occasionally, if the sleep apnoea is due to a more central cause rather than airway obstruction, surgery may not be helpful. That is uncommon, but it is an important reason why careful assessment matters.
I have separate pages that explain tonsillectomy and adenoidectomy in more detail, including what the operations involve, recovery, and risks, so those can be read alongside this page.
Does every child with snoring need surgery?
No. Children with simple snoring and no convincing features of apnoea are not always helped by surgery. The decision depends on the pattern and severity of symptoms, examination findings, and whether there is evidence that breathing during sleep is genuinely being disrupted.
When are sleep studies useful?
Sleep studies are helpful when the diagnosis is uncertain, when the severity is unclear, or when a child is in a higher-risk group.
In practice, sleep studies are particularly useful when:
the history is not clear
symptoms do not match the examination findings
the child is very young
there are medical comorbidities
the severity of obstruction needs to be defined more carefully before surgery
What kind of sleep study might be done?
This varies. Some children may have overnight pulse oximetry, sometimes performed at home or in hospital. Others may need a more formal sleep study such as polysomnography, especially if there are additional risk factors or more complex concerns.
Is a voice or video recording helpful?
Yes — very much so.
A short recording of your child sleeping can be extremely useful in clinic. It often helps show the pattern of snoring, the effort of breathing, any pauses, mouth breathing, or gasping sounds in a way that is much clearer than description alone. A brief video or audio recording on a phone can therefore be very helpful to bring to the consultation, particularly if the symptoms are intermittent or difficult to describe accurately.
What else might I ask about in clinic?
When assessing a child with possible sleep-disordered breathing, I usually want to know about:
snoring frequency
pauses in breathing
restless sleep
mouth breathing
nasal blockage
daytime tiredness or irritability
concentration or behavioural change
recurrent tonsillitis
any concerns about growth, development, or other medical conditions
This helps work out whether the issue is simple snoring, sleep-disordered breathing, or more convincing obstructive sleep apnoea.
What should I expect after surgery?
If surgery is recommended, the aim is to improve breathing during sleep by treating the obstruction. However, it is important to know that there may not be an immediate improvement in the first few days after surgery. This is because swelling in the throat and nose after an operation can temporarily affect the airway before healing settles down.
In most children, breathing improves as recovery progresses, but the improvement is not always instant.
When is further assessment particularly important?
More careful assessment is especially important in children who are very young or who have other medical conditions. This includes children with obesity, Down syndrome, craniofacial differences, neuromuscular conditions, or other significant comorbidities, because the decision-making around surgery and post-operative care may be different.
Disclaimer
This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.