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Home > Sleep Disorders > Pediatric Sleep Disorders > Obstructive Sleep Apnea

Obstructive Sleep Apnea

Obstructive sleep apnea syndrome (OSAS) is a common problem in children, and is increasing being recognized as a cause of daytime attentional and behavioral problems.

Unlike adults with sleep apnea, who are often overweight and frequently wake up at night, children with OSA are more difficult to recognize and diagnose.


Although snoring is a common symptom in children with obstructive sleep apnea, it is important to remember that between 10-20 percent of normal children snore (primary snoring) on a regular or intermittent basis.

In addition to continuous loud snoring, other symptoms of obstructive sleep apnea in children include:

  • failure to thrive (weight loss or poor weight gain)
  • mouth breathing
  • enlarged tonsils and adenoids
  • problems sleeping and restless sleep
  • excessive daytime sleepiness
  • daytime cognitive and behavior problems, including problems paying attention, aggressive behavior and hyperactivity, which can lead to problems at school


The diagnosis of OSA in children is usually based on the characteristic symptoms and evidence of adenotonsillar hypertrophy (big tonsils and adenoids) and mouth breathing. Children suspected of having OSA should usually be evaluated by a Pediatric ENT specialist for further evaluation.

If necessary, further testing might include polysomnography (a pediatric sleep study).


Although most younger children with OSA are not overweight, if a child is overweight, that might contribute to his symptoms. Weight loss is therefore important for overweight children with obstructive sleep apnea.

Other underlying medical conditions, especially allergies, should also be treated. A nasal steroid might help improve nasal obstruction and OSA symptoms in children that also have allergies.

The main treatment for kids with OSA is surgery, with removal of the child's enlarged tonsils and adenoids (tonsillectomy and adenoidectomy or T&A).

What You Need To Know

  • As in adults, obstructive sleep apnea can cause a lot of complications, including poor growth, headaches, high blood pressure and other heart and lung problems.
  • OSA, and sleep problems in general, are increasingly being recognized as a cause of children's daytime school and behavioral problems. If your child is having problems at school or with his behavior and he snores loudly, you should ask your Pediatrician about OSA.
  • Children with Down Syndrome are at big risk for OSA and should be closely watched for symptoms. Other medical conditions, including various neuromuscular and central nervous system abnormalities, craniofacial abnormalities, like Pierre Robin sequence, Treacher Collins syndrome and Crouzon syndrome, are also often associated with OSA.

What is Sleep Apnea?

Sleep Apnea is a problem with frequent awakening caused by blockage of the airway at night. In kids, this is usually due to the tonsils and adenoids. Your child may snore, or mouth-breathe loudly. Sometimes sleepwalking or sleeptalking is a sign of sleep-disordered breathing. You child may just be retless, tossing and turning all night. Bed-wetting and excessive sweating during sleep can also be seen. Some kids with Sleep Apnea are tired during the day, but sometimes sleep disruption has the opposite effect in kids, and they may be over-active or "wired". In fact, some kids diagnosed with ADHD may actually have Sleep Apnea.