When a child sleeps, the upper airway naturally relaxes. If this relaxation is coupled with some degree of obstruction, the resulting turbulent airflow forces the soft tissues in the back of the throat to vibrate, causing snoring. While 10 to 20 percent of children snore occasionally, it is often a source of parental concern. Sleep-disordered breathing ranges from simple, benign snoring to a severe medical condition known as Obstructive Sleep Apnea Syndrome (OSAS). This article clarifies the distinction between normal and worrisome snoring and outlines the steps for diagnosis and management.
When Snoring Is Normal Versus Concerning
The frequency and quality of the sound indicate whether a child’s snoring is normal or concerning. Primary snoring is soft, infrequent, and occurs less than two nights per week. This occasional snoring is often benign and may be triggered by temporary factors like an upper respiratory infection, a cold, or seasonal allergies causing nasal congestion. These transient blockages resolve once the underlying illness subsides, and the child shows no signs of disturbed breathing or daytime impairment.
Snoring becomes a concern when it is loud, heavy, and occurs habitually (three or more nights a week). This habitual pattern suggests a structural or chronic issue consistently narrowing the airway during sleep. Parents should observe for signs of labored breathing, such as a struggling chest or abdomen, which indicates the child is working harder to inhale.
The most concerning signs are observed breathing pauses, gasping, choking, or snorting sounds that interrupt the snoring. These interruptions are often followed by a brief arousal from sleep, indicating the body is struggling to restore airflow. Problematic snoring is also associated with daytime symptoms like chronic mouth breathing, difficulty waking, or morning headaches, signaling poor sleep quality.
Underlying Causes of Problematic Snoring
The physical basis for problematic snoring and OSAS is typically found in the upper airway anatomy. The most common cause, especially in preschool and school-aged children, is the enlargement of the adenoids and tonsils, known as adenotonsillar hypertrophy. These masses of lymph tissue, located at the back of the throat and nasal cavity, physically obstruct airflow when they become large or inflamed. The peak incidence of OSAS coincides with the most prominent growth of this lymphoid tissue, usually between two and eight years of age.
Structural differences in the face and jaw can also predispose a child to airway narrowing. Craniofacial anomalies or a naturally narrow palate reduce the space available for air to pass through during sleep. These factors decrease the airway’s diameter, making it more susceptible to collapse when the muscles relax.
Chronic inflammation from conditions like allergic rhinitis or persistent nasal congestion contributes to snoring by forcing mouth breathing. This shift in breathing pattern alters the position of the tongue and soft palate, increasing tissue vibration and obstruction. Childhood obesity is also a contributing factor, as increased fatty tissue around the neck can compress the upper airway, making it less stable and increasing the risk of collapse.
Impacts of Untreated Childhood Sleep Apnea
The consequences of chronic, untreated obstructive sleep apnea affect multiple facets of a child’s health and development. Repeated airway blockage causes fragmented sleep and, in severe cases, intermittent drops in blood oxygen levels. This lack of consistently restorative sleep directly affects neurocognitive function, leading to issues with learning and attention.
Children often experience difficulty with concentration, memory, and executive function, resulting in decreased academic performance. Unlike adults who typically exhibit daytime sleepiness, children often manifest sleep deprivation as hyperactivity, aggression, and irritability. This presentation can sometimes lead to the misdiagnosis of behavioral issues, such as Attention-Deficit/Hyperactivity Disorder (ADHD), when the underlying problem is a sleep disorder.
The chronic strain of obstructed breathing negatively impacts physical health. Repeated drops in oxygen and increased breathing effort stress the cardiovascular system, potentially contributing to hypertension (high blood pressure). Furthermore, the disruption of normal sleep architecture can interfere with the nocturnal release of growth hormone, potentially contributing to delays in growth and development.
Next Steps: Diagnosis and Management
If parents observe persistent, loud snoring accompanied by gasping or noticeable breathing pauses, they should schedule an evaluation with a pediatrician or specialist. An Ear, Nose, and Throat (ENT) specialist or a pediatric sleep medicine physician can conduct a thorough examination of the upper airway and review the child’s sleep history. This initial clinical assessment is crucial for determining the need for further diagnostic testing.
The definitive diagnostic tool for confirming OSAS is an overnight sleep study, known as Polysomnography (PSG). Performed in a sleep lab, this test non-invasively monitors several factors throughout the night.
PSG Monitoring Factors
- Brain activity
- Eye movement
- Heart rate
- Breathing effort
- Blood oxygen levels
The PSG provides objective data on the number and severity of obstructive events, effectively distinguishing between primary snoring and true sleep apnea.
For most children diagnosed with OSAS, the first-line treatment is adenotonsillectomy (T&A), the surgical removal of the adenoids and tonsils. Since enlarged lymphoid tissue is the most common cause, this procedure often resolves the condition entirely, leading to significant improvements in sleep and daytime behavior. For milder cases or children not suited for surgery, non-surgical management options include intranasal steroid sprays to reduce upper airway inflammation or, for children with obesity, a focus on weight management. Continuous Positive Airway Pressure (CPAP) therapy is reserved for more severe cases or those who do not respond to T&A.