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Obstructive sleep apnea

What is sleep apnea?

Paediatric obstructive sleep apnea (OSA), or sleep apnea, happens when a child's airway becomes partially or completely blocked while they are sleeping. The blockage of the airway can cause snoring, gasping, pauses in breathing and changes in the body's oxygen levels. 

Sleep apnea affects one to five children in 100. If your child snores, for example, it may not always be due to sleep apnea.

What causes sleep apnea?

Common causes of sleep apnea in children are larger than normal tonsils or enlarged adenoids at the back of the nasal passages (the airways behind the nose). Other possible causes include:

  • a child being overweight or obese
  • weakness in the muscles involved in breathing, such as the diaphragm and muscles in the neck and around the ribs, such as in a neuromuscular disease (a disease that affects the nerves and muscles)
  • the shape and size of a child's skull and jaw
  • other health conditions that affect your child's airways or ability to breathe.
Tonsils and adenoids
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Common causes of sleep apnea include enlarged adenoids or tonsils.

Why is it important to diagnose and treat sleep apnea?

It is important to diagnose sleep apnea early. If it is not treated, it can be linked to other health issues, such as:

Night-time symptoms of sleep apnea

If your child has sleep apnea, you will recognize a number of signs while you watch them sleep. These may include:

  • snoring – this may be continuous or with pauses or may only occur in certain body positions (for example while your child lies flat on the back) or during certain periods of sleep
  • breathing only through the mouth
  • restless sleep
  • long pauses in breathing
  • frequently waking up at night
  • sweating.

When your child is experiencing restless sleep, they may be turning from side to side, jerking their legs or sitting up in an attempt to breathe better while still asleep.

Daytime symptoms of sleep apnea

Because your child is waking up many times during the night, they are not rested in the morning. As a result, they may have the following symptoms during the day:

  • sleepiness, especially at school or during quiet activities
  • learning difficulties
  • poor concentration for homework
  • lack of energy for sports and hobbies
  • irritability, hyperactivity, impulsivity or aggression.

How is sleep apnea diagnosed in children?

Your health care provider will usually refer your child to a sleep medicine specialist in the hospital. The sleep medicine specialist will meet with you to see if your child's symptoms need a closer look. If so, your child will come back to the hospital for a sleep study.

This study is an overnight sleep "test" during which your child will have wires attached to their skin with paste and child-friendly tape. The wires do not hurt and are connected to a machine. As your child sleeps, the machine will record their oxygen level, breathing pattern, heart beat and sleep pattern. A sleep technologist will also observe your child during the study.

Once the sleep study is over, a sleep respiratory therapist will study the recordings on the machine to identify type of sleep problem your child has and how serious it is.

How is sleep apnea treated?

Sleep apnea can be treated with:

In some cases, your child's health care provider will recommend supplemental oxygen therapy at night until surgery can be scheduled.

If your child has other medical conditions that may affect or be affected by sleep apnea, the sleep medicine team may refer them to other specialists and clinics to make sure they get the best treatment.

Key points

  • Obstructive sleep apnea (OSA) occurs when a child’s airway becomes blocked while they are sleeping.
  • Common causes of sleep apnea in children are larger than normal tonsils or enlarged adenoids. Other causes include excess body weight and weakness in the muscles involved in breathing.
  • Night-time symptoms of sleep apnea include snoring, breathing through the mouth and restless sleeping. Daytime symptoms include drowsiness, poor concentration and lack of energy.
  • Sleep apnea is diagnosed through a sleep study. Treatment can include surgery, a weight loss program or positive airway pressure.

Debra L. Medin, MS RRT RPSGT​


At SickKids

The sleep medicine team at SickKids includes:

  • a respirologist - a doctor specially trained to diagnose and manage sleep disorders in children
  • a nurse practitioner
  • a respiratory therapist
  • a sleep technologist
  • a child life specialist.

Other members of the health care team, such as a social worker or a psychiatrist, may provide specialized care when needed.​