Pediatric Dental Health

May 1, 2002

SNORING IN CHILDREN
Many children snore when they sleep. Most of the time childhood snoring is harmless and benign. Benign snoring, affecting 7% to 10% of children, doesn't affect health. The prevalence of snoring in children decreases with age.

In some cases, however, snoring may a symptom of a problem called obstructive sleep apnea syndrome (OSAS). Obstructive sleep apnea (OSA) is defined as poor lung oxygenation caused by upper airway obstruction during sleep. The problem is thought to affect up to 3 percent of children.

WHAT ARE THE RISK FACTORS ASSOCIATED WITH SNORING?

Enlarged tonsils or adenoids.
Nasal obstruction.
Upper respiratory tract infections.
Rhinitis (nasal discharge).
Deviated septum (nose).
Secondary smoke from parent’s smoking.
Inability of the central nervous system to generate enough muscle tone to keep the airway open.
Central sleep apnea.

WHAT IS OBSTRUCTIVE SLEEP APNEA SYNDROME?
Obstructive sleep apnea syndrome (OSAS) affects 0.7% to 10.3% of children. More than 500,000 children in the United States suffer from obstructive sleep apnea.
Apnea is the medical term for the lack of breathing that lasts more than 10 seconds.
Obstructive sleep apnea occurs when there is a partial or complete obstruction of the airway Obstructive apnea is a respiratory event in which there is complete cessation of airflow through the nose and mouth – despite continued inspiratory and expiratory respiration efforts.
Most children who have OSA (obstructive sleep apnea) are between 2 and 5 years of age.
Symptoms of OSAS include: difficulty breathing during sleep, snoring, or mouth breathing during sleep.

HOW IS OBSTRUCTIVE SLEEP APNEA DIAGNOSED?
First, a complete physical examination should be performed in children with suspected OSA.
The lungs and cardiovascular system should be examined for possible consequences of OSA. A thorough head and neck exam should include documentation of tonsil size.
OSA is diagnosed in a sleep laboratory using polysomnography.
Polysomnography is considered the gold standard for diagnosing obstructive sleep apnea. In this technique, multiple physiologic measurements are taken while the child is asleep in the laboratory. The physiologic parameters measured in a sleep study include: detection of rapid eye movement, electroencephalogram, chest movement monitors, nasal and oral air flow measurements, electrocardiogram, electromyogram, and pulse oximetry. Sleep laboratory studies cost between $800 and $1,400.

WHAT IS THE TREATMENT FOR OBSTRUCTIVE SLEEP APNEA IN CHILDREN?
The options for treating OSA include: observation, medical treatment, mechanical intervention, or surgical management.
Medical treatment includes: treatment of infections of the tonsils and adenoids.
Mechanical intervention includes: continuous positive airway pressure (CPAP). With CPAP, the child wears a snugly fitting nasal mask, which is attached to a device which blows air into the nostrils. CPAP is effective treatment in children, but is usually used when adenotonsillectomy is not performed.
Surgical management includes: tonsillectomy and adenoidectomy. Surgical removal of the obstructing tissue is the most common way of treating OSA in children. Adenotonsillar hypertrophy (enlarged tonsils) is the most common cause of obstruction. Adenoidectomy is curative in 75% to 100% of children with OSAS, including those who are obese

A technical report in Pediatrics is designed to help primary care clinicians: recognize OSAS, identify the best procedures for diagnosing OSAS, identify risks associated with pediatric OSAS, and evaluate management options for OSAS.

Schechter, MS. Technical Report: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics. April 2002; 109(4)

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