Sleep-Disordered Breathing in Children
Distinct pediatric phenotype
Pediatric OSA differs from adult disease. Adenotonsillar hypertrophy is the dominant cause, and obesity is a risk factor but not required. Children often present with mouth breathing, snoring, restless sleep, enuresis, growth faltering, and behavioral or learning problems rather than classic daytime sleepiness. Normal children may have occasional apneas; the diagnostic threshold is an obstructive AHI of 1 or more per hour, or obstructive hypoventilation.
Diagnosis and management
PSG is the reference standard, especially before surgery in complex children. Adenotonsillectomy is first-line for otherwise healthy children with adenotonsillar hypertrophy. Residual disease after surgery is common in obese children and those with craniofacial syndromes; repeat evaluation is warranted. CPAP is used when surgery is not curative or not feasible. Anti-inflammatory therapy (intranasal corticosteroids, montelukast) may help mild disease.
Traps
- Do not apply adult AHI thresholds to children.
- Behavioral symptoms may be mistaken for ADHD; ask about snoring.
- Central apnea in infants can be normal; the question may test the distinction from pathologic central events.
- Enuresis and poor growth are pediatric clues often missed.
Rule of thumb
In a snoring child with behavioral problems and large tonsils, think OSA and consider adenotonsillectomy; recheck for residual disease if symptoms persist.