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Help! My Child Snores!

"What are the causes of OSAS in children?"
By: Ma. Jocelyn A. Niere-Quidlat, MD, FPPSHelp! My Child Snores!

It is common knowledge that adults snore a lot. But do children snore as well? Should snoring in children be a cause of concern? Primary snoring, which is defined as snoring without obstructive apnea (suspension of breathing caused by obstruction in the upper airway), arousals from sleep, or abnormalities in gas exchange does not pose as a problem for children. If the snoring is related to obstructive sleep apnea syndrome (OSAS), however, then that is something parents should worry about.

Descriptions of this condition were given by Dr. William Osler more than a century ago. Pediatric OSAS was described more in detail by Dr. Christian Guilleminault and colleagues in 1976. What exactly is OSAS? Obstructive sleep apnea is defined as the cessation of airflow during sleep at the nose and mouth in spite of continued breathing because of an obstruction in the upper airway. This is observed in about 2 percent of preschool children; it’s more common at 2 to 6 years of age. OSAS, however, can be observed in any pediatric age, from the neonatal period throughout adolescence.

The upper airway above the level of the epiglottis is a hollow tube. It is usually patent (open) but may normally potentially collapse in order to facilitate swallowing and talking. In children with OSAS, the upper airway collapses abnormally during sleep.

The most common cause of the narrowing of the upper airway in children with OSAS is the increase in size of the tonsils and the adenoids (“tonsils” in the throat area behind the nasal cavity). Other common causes of structural narrowing include craniofacial (skull) abnormalities and obesity. Children with muscular dystrophy, cerebral palsy, Down Syndrome, and hypothyroidism are also at risk.

A lot of the affected children have a history of snoring and difficulty with breathing during sleep.  Children with OSAS have continuous loud snoring that can often be heard outside the bedroom. At the end of obstructive episodes, the child may have gasping movements, or is awakened from sleep. The child is restless and may adopt unusual sleeping positions like sleeping in a seated position and/or with neck hyperextended. The child may have excessive sweating and become pale or bluish in appearance. It can be alarming to parents, so some stay awake at night just to keep watch over the child or to reposition him throughout the night. 

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