Children are less likely than adults to have sleep apnea, but it still affects about 6 percent of children. Sleep apnea, also called pediatric sleep apnea, can look different in children than in adults. Over time, it may lead to serious health problems.

Knowing the signs of sleep apnea can help you get your child the care they need sooner. This article explains the symptoms of sleep apnea in children, how it can affect health and development, how it’s diagnosed, and treatment options that may help.

How Sleep Apnea Shows Up in Children

Pediatric obstructive sleep apnea (OSA) is a condition that causes a child’s breathing to pause during sleep due to a partial or complete blockage in their upper airway. When the brain senses that breathing has changed, it sends a signal to the breathing muscles, often causing a gasp or snort and a brief wake-up. In children, sleep apnea is the most common between the ages of 2 and 6, although it can occur in babies as well.

Snoring in Children

Your first clue that your child has sleep apnea may be that they snore or seem to have trouble breathing at night. Most children don’t snore, so it’s a good idea to talk to a doctor if your child is snoring. Researchers think that about 10 percent to 20 percent of children who snore have OSA. However, babies and young children can have sleep apnea without snoring.

Other nighttime symptoms of childhood sleep apnea include:

• Mouth breathing
• Restless sleep, including tossing and turning
• Coughing or choking
• Nighttime sweating
• Sleepwalking or talking
• Bedwetting, especially after long periods of being dry at night

Daytime Sleep Apnea Symptoms in Children

Symptoms of sleep apnea are also likely to show up during the day. These daytime symptoms often look different in children than in adults. While adults are more likely to have excessive daytime sleepiness, children are more likely to have behavioral problems.

Symptoms of sleep apnea during the daytime include:

• Hyperactivity or difficulty paying attention
• Behavioral issues like aggression or irritability
• Learning difficulties or doing poorly in school
• Morning headaches
• Falling asleep at school or during short car/bus/train rides

How Sleep Apnea Can Affect Health and Development in Children

Sleep apnea in children is often very treatable. But without treatment, it can cause longer-term problems. Every time your child stops breathing at night, the brain wakes them up. These constant wake-ups lead to extremely poor quality of sleep.

In addition to making them feel tired, cranky, and easily distracted, this lack of good sleep can also cause health issues, including problems with growth and development.

Research studies have also shown that some children who have attention-deficit/hyperactivity disorder (ADHD) may actually have sleep apnea, which is causing their ADHD.

Heart, Lung, and Metabolic Issues

Breathing problems at night can also cause the body to not get enough oxygen. If sleep apnea is severe enough to cause low blood oxygen levels over the long term, this can cause permanent damage to the heart and lungs.

Children who aren’t treated may also have a higher risk of possible complications, including high blood pressure, high cholesterol, and blood sugar issues that can cause diabetes.

How Doctors Diagnose Sleep Apnea in Children

To diagnose your child, your healthcare provider will first ask about symptoms and do a physical exam.

They may also do some tests, including taking a closer look at your child’s airway using an X-ray or endoscope. The best way to diagnose sleep apnea is a polysomnography (a sleep study).

What To Expect in a Childhood Sleep Study

A sleep study usually involves going to sleep in a special lab, while connected to monitors and equipment that collect information about what’s happening during sleep.

The sleep study measures:

• Brain activity
• Movement and muscle activity
• Heart activity
• Oxygen and carbon dioxide levels
• Airway airflow
• How often the person stops breathing

To prepare for a sleep study, your child should get a normal night’s sleep the night before, avoid caffeine, take their normal medicines, and avoid napping the day of the study. Usually, a parent can stay with the child through the night, and the study will be finished in time for the child to go to school the next day.

Diagnosis Criteria

Children don’t need to have as many sleep interruptions per hour as adults to be diagnosed with sleep apnea. If a child has more than one breathing interruption per hour, that’s OSA. In adults, the cutoff is higher: five per hour for a mild case and 15 for a moderate case.

Treatment Options for Children With Sleep Apnea

Children with mild sleep apnea may grow out of it. But if treatment is needed, your child’s doctor may recommend several options.

Allergy Treatment

Sometimes, nasal congestion from allergies can cause or worsen sleep apnea. Inhaled steroid allergy medicine like fluticasone can help. It is also often helpful to avoid dust, smoke, and other allergens. Secondhand smoke is harmful to children and can make sleep apnea worse. It’s important not to let anyone smoke in your house or car.

Tonsil Removal Surgery

In children with moderate to severe sleep apnea, doctors often recommend surgery to remove the tonsils and adenoids, also called a tonsillectomy or an adenotonsillectomy. The surgery removes enlarged tonsils to create more room, opening the airway.

Among otherwise healthy children who do not have obesity, a tonsillectomy has about a 75 percent success rate of curing OSA. Although getting your tonsils out may be better known as a procedure to prevent recurrent infections, it’s actually much more common these days to get a tonsillectomy for sleep apnea than it is for infections.

Weight Loss

Children with obesity (in the 95th percentile or greater of BMI for their age) are at a higher risk of sleep apnea. Up to 60 percent of children with obesity also have OSA.

Excess weight can cause sleep apnea when fat around the neck presses down on the airway, making breathing more challenging, especially when lying down. Because of this, doctors often recommend lifestyle changes to get your child to a healthy weight before recommending something like surgery.

Increased physical activity has been found to both promote weight loss and help improve sleep apnea even independently of whether the child loses any weight. Doctors also recommend sticking to regular mealtimes and eating without distractions like the TV.

CPAP Therapy

Sleeping with a continuous positive airway pressure (CPAP) machine is a common sleep apnea treatment. A CPAP machine uses a mask or nosepiece to deliver pressurized air that helps keep airways open during sleep. In one study, over 86 percent of children had breathing interruptions reduced to less than one per hour thanks to CPAP therapy.

Orthodontic Device

In some children, an orthodontic treatment called rapid maxillary expansion can be helpful. This device can help create more space in the airway by widening the palate and nasal passage. However, health experts disagree on how effective this treatment is on its own.

Your healthcare team will consider many factors, including your child’s age, weight, and other health conditions, when considering the best treatment for them.

Talk to Your Doctor

If you think your child may have sleep apnea, talk to their doctor as soon as possible. Getting treatment early can improve your child’s sleep, behavior, and overall quality of life.

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

How do you manage your child’s sleep apnea? Let others know in the comments below.