RWJ Hamilton SleepCare Center

The childhood form of obstructive sleep apnea (OSA) has been estimated to occur in one to three percent of otherwise healthy children. Although it is observed most commonly in children from two to six years of age, OSA can occur in infants and adolescents as well and can result in significant morbidity and mortality.

OSAS may present only subtle or indirect symptoms:

• Daytime agitation
• Behavioral problems
• Hyperactivity
• Attention deficit problems
• Impaired school performance

Children exhibiting any of the following symptoms should be considered prime candidates for evaluation:

• Snoring with a history of difficulty breathing during sleep
• Impaired growth
• Neurobehavioral indicators such as poor grades in school
• Agitation / attention deficit problems or hyperactivity

Although snoring is the major symptom of childhood OSA, most snoring children do not have OSA. Recent studies suggest that about 10 percent of children snore nightly, but only about 20 percent of these children actually have OSA. In other words, about 70 to 80 percent of children who snore nightly do not have OSA and don't need surgical treatment with adenotonsillectomy. It is, therefore, recommended that the diagnosis of childhood OSA be established prior to surgery.

Unlike adults, who exhibit obvious repetitive episodes of obstructive sleep apnea, the clinical manifestations of childhood OSA are more subtle. Children may exhibit continuous partial upper airway obstruction (obstructive hypoventilation) as their main pattern of abnormal breathing. Without objective testing, it is impossible for an observer to tell the difference between obstructive hypoventilation (with hypoxia and/or CO2 retention) and just snoring.

Children who exhibit excessive daytime sleepiness (EDS), sleep fragmentation or poor sleep quality may experience subtle daytime symptoms such as agitation, attention deficits, difficult behavior and poor school performance.