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Sleep Apnoea in Children

Replay of our webinar - Sleep Apnoea in Children on the 16th September 2021

Watch the video to learn why regular snoring and pauses in breathing is not normal in children from sleep professionals, Professor Heather Elphick (paediatric medical advisor of our charity) and Janine Reynolds - both from the Sheffield Children's Hospital's Sleep Services Department. Listen to Carolanne Murphy, trustee of our charity and Mum to 3 children with sleep apnoea.

Sleep Apnoea is by no means a condition specific to adults, and in fact when adults get diagnosed they can often trace the signs and symptoms back to their own childhood.  The British Lung Foundation here in the UK state "OSA (Obstructive Sleep Apnoea) is quite common and may affect up to 1 in 30 children. It affects boys and girls equally."  There is a wealth of information on their website for OSA in Children

Central Sleep Apnoea also affects children in the same way it affects adults, due to neuromuscular conditions, brain stem problems, certain medications and other causes - plus it can be idiopathic.  The risk of Sleep Apnoea is also high in people with Down's Syndrome. As with adults, children can also have Mixed/Complex Sleep apnoea.

One of the biggest causes of Obstructive Sleep Apnoea in children is large tonsils and/or adenoids, and children have a much higher success rate of being cured by tonsillectomy and/or adenoidectomy than adults.

ADHD is often misdiagnosed in children who have undiagnosed Sleep Apnoea and other sleep disorders, yet when they get diagnosed and treated, usually daytime symptoms of ADHD will either improve or even totally reverse.

Dr Stephen Sheldon, a pioneer in the field of paediatric sleep, explains in the video below why it's important to evaluate the sleep in ADHD sufferers,  as in his opinion, the root cause in 75% of these children is due to a sleep disorder.

Below is a short story of one mother's quest to discover the real truth of what was causing her son's dreadful battle with what appeared to be ADHD, and it has a lovely ending for Connor and his family.  The relief must truly have been miraculous for them!

Signs To Watch Out For During Sleep

  • Regular snoring and noisy breathing.
  • Breath-holding and pauses in breathing.
  • Repeated Nocturnal Enuresis (bed wetting).
  • Tooth grinding (bruxism)
  • Heavy Sweating.
  • Restlessness
  • Sleeping in unusual positions - often with the neck stretched as if trying, subconsciously, allow more air in.
  • Frequent night terrors.
  • Sleep walking is more common in children with Sleep Apnoea.
  • Mouth breathing during sleep is more common in children with Sleep Apnoea.
  • Rapid movements from the chest and/or abdominal walls.

Daytime Symptoms

  • Children can display symptoms of either daytime sleepiness or, at the other end of the scale, hyperactivity.
  • Lack of concentration.
  • Disruptive behaviour and can be wrongly labelled as 'the naughty child' at school/nursery.
  • Depression and this can get worse as the child gets older.
  • Failure to thrive physically (but not always).
  • Weak immunity and susceptible to picking up illnesses. 
  • Recurrent ear and throat infections are signs of enlarged tonsils and adenoids which can often be fixed with surgery.
  • Struggle academically and have cognitive problems.
  • ADHD, OCD and other behavioural issues can be suspected or even diagnosed.
  • May be misdiagnosed with asthma and using unnecessary inhalers.
  • May be mouth-breathers and have nasal sounding speech.

Long-term Consequences of Untreated Sleep Apnoea

As well as the above symptoms for children living with untreated sleep apnoea, if the sleep apnoea remains undiagnosed and untreated, there are many other physical and mental health risks which develop over time - see 'What is Sleep Apnoea?' Incidentally, many adults being treated for sleep apnoea can trace the signs and symptoms right back to childhood, and it does tend to run in families, so if you have a child with sleep apnoea it is wise to check for signs and symptoms in both parents in case they too are suffering from this untreated.

Causes for Obstructive Sleep Apnoea in Children:-

  • Large Tonsils and/or Adenoids.
  • Nasal Blockage, due to deviated septum, narrow passages, congestion, allergies etc.
  • Large Uvula.
  • Large Neck Size.
  • Obesity.
  • Large Soft Palate.
  • Receding Jaw.
  • Large Tongue or Tongue Tie.
  • Brain slow to send messages to breathe (this is known as Central Sleep Apnoea and is not as common as Obstructive Sleep Apnoea).
  • Family member with Sleep Apnoea, as there are hereditary factors due to craniofacial issues.
  • OSA is more common in children with certain syndromes, eg Down's Syndrome

If You Suspect Your Child May Have Sleep Apnoea

There are several routes to take, but the most important one is TAKE ACTION NOWUntreated Sleep Apnoea can affect the brain and other organs, but a study published in 2012 confirmed that Brain Injury And Cognitive Deficits Reverse With Treatment Of Childhood Obstructive Sleep Apnea, so the sooner it is treated the better!

  • Book an appointment to discuss this with your GP, who should refer you to a Specialist Paediatric Sleep Clinic, or a Specialist Paediatric Respiratory Clinic in places where there is no sleep clinic, as OSA should be treated within the respiratory field.
  • Observe your child when sleeping and if possible take a video recording if you spot any signs your child is struggling to breathe.
  • Try to encourage your child to sleep on their side, as Sleep Apnoea is usually worse when laid on the back.
  • Raising the head of the bed by 4-6 inches can help.
  • Address any nasal congestion, and be guided by your GP how to do this, depending on the cause of the congestion.

It is NOT normal for a child to snore or stop breathing on a regular basis during sleep. Once the Sleep Apnoea is treated - whether it be via tonsillectomy/adenoidectomy, CPAP or other means, most children will sleep safely and soundly, and so will the parents and carers - just importantly they will be protected from the damage untreated Sleep Apnoea can cause!

UK NHS Specialist Paediatric Respiratory Sleep Clinics

Sheffield Children's Hospital, Sheffield

Alder Hey Children's Hospital, Liverpool

Great North Children's Hospital, Newcastle-upon-Tyne 

Imperial College Healthcare, London

Great Ormond Street Hospital for Children (GOSH), London

NHS Lothian - Royal Hospital for Children and Young People (RHCYP), Edinburgh

NHS Greater Glasgow & Clyde - Royal Hospital for Children, Glasgow

Helpful Resources:-

If your child does need to use a CPAP machine or a non-invasive ventilator, which will not only keep them safely breathing whilst sleeping, but will also improve the health and well-being during the day here are some helpful free and paid resources:-

CPAP Tips for Kids by the AASM Sleep Education

A free video to watch by the AASM Sleep Education to help children adhere to using their CPAP and understand why it's important to use it.


The Magical Mask

A lovely book, 'The Magical Mask' which is free to download, based on a story by Keren Stronach who used it to help her own daughter to wear her CPAP mask. Click on the image to download and print.

A Monkey, a Mouse and a CPAP Machine

Book to purchase by the late Marion Maz Mason and her son Steve B Mason. The main aim of this book is to subtly take the fear out of CPAP devices in children, as the book just treats it as a ‘normal’ part of life.
Click on the image to see more and purchase.