Clinical Review Clinical review

Paediatric obstructive sleep apnoea

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1918 (Published 14 April 2010) Cite this as: BMJ 2010;340:c1918
  1. Steven Powell, specialist registrar, otolaryngology1,
  2. Haytham Kubba, consultant paediatric otolaryngologist2,
  3. Chris O’Brien, consultant paediatrician3,
  4. Mike Tremlett, consultant anaesthetist4
  1. 1Department of Otolaryngology, James Cook University Hospital, Middlesbrough TS4 3BW
  2. 2Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow G3 8SJ
  3. 3Department of Paediatric Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  4. 4Department of Anaesthesia, James Cook University Hospital, Middlesbrough TS4 3BW
  1. Correspondence to: S Powell steven_m_powell{at}hotmail.com
  • Accepted 1 April 2010

Summary points

  • Obstructive sleep apnoea has a prevalence of 0.7% to 1.8% in the paediatric population

  • The condition can be difficult to diagnose clinically

  • Even mild to moderate obstructive sleep apnoea can result in adverse neurobehavioural consequences and negatively affect quality of life

  • Adenotonsillectomy is an effective treatment in most uncomplicated cases

  • More complex cases need management by paediatric and ear, nose, and throat teams in hospitals with appropriate support facilities

Habitual snoring occurs in 12% of children in the United Kingdom.1 Two large cross sectional studies from the UK and Italy found that the prevalence of obstructive sleep apnoea in children was 0.7% to 1.8%.1 2 A recent, well designed cross sectional study of 700 children in the United States found that the prevalence of primary snoring was 15.5% and of sleep apnoea 1.2%.3 Delayed diagnosis of obstructive sleep apnoea can lead to neurobehavioural consequences and even serious cardiorespiratory morbidity.4 History and examination alone are insufficient to distinguish reliably those with sleep apnoea from those who simply snore.5 Paediatric obstructive sleep apnoea has completely different clinical features and requires different management strategies from adult obstructive sleep apnoea. In this review we provide an overview of the diagnosis and management of children with obstructive sleep apnoea, from primary to specialist care. The review is based on the best available evidence, which for much of obstructive sleep apnoea comprises longitudinal or cohort studies.

How do snoring and obstructive sleep apnoea differ?

Sleep disordered breathing refers to the whole spectrum of breathing disturbance during sleep, from primary snoring through to obstructive apnoea. Obstructive sleep apnoea is defined as a disorder of breathing during sleep that is characterised by prolonged partial upper airway obstruction and/or intermittent complete obstruction that adversely affects ventilation during sleep and disrupts normal sleep patterns.6 Snoring is noisy breathing caused by turbulent airflow …

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