Children • Snoring and some of the consequences

Most children snore occasionally and roughly 10% of them snore most nights. It occurs when they breathe in but there is a blockage of the air passing through the back of the mouth and it causes vibration of the throat tissues.

Three pupils in classroom, one of them sleeping

Sometimes snoring is a sign of a respiratory infection, a stuffy nose or allergy but at other times it may be a bigger problem.

Amongst the contributing factors to snoring may be obesity, allergies, asthma, reflux disorder, or even an abnormality in the structure of the jaw. In children, the most common problem associated with snoring is large tonsils. Young children’s tonsils are quite large in comparison to the throat, peaking at 5-7 years of age. These block the airway, making it difficult to breathe.

As many as 3% of children not only snore, but also suffer from breathing problems during their sleep. When snoring is accompanied by gasps or pauses in breathing, the child may have OSA – obstructive sleep apnoea.

Children’s muscles normally relax during sleep and can become so relaxed that the airway is narrowed and sufficient air cannot pass through causing a pause in breathing that can last a few seconds or as long as a minute. The brain is then alerted and signals the body to start breathing again. This results in the child gasping or snorting, waking up and starting to breathe again. Because of these repeated interruptions, the child may not get enough quality sleep and is likely to be sleepy or overtired during the day.

Undiagnosed and untreated sleep apnoea may contribute to daytime sleepiness and behavioural problems including difficulties at school. In one recent study, children who snored loudly were twice as likely to have learning problems. Following a night of poor sleep, children are also more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit/hyperactivity disorder (ADHD). Sleep apnoea may also be associated with delayed growth and cardiovascular problems.

During the night, children with sleep apnoea may:

  • Snore loudly and on a regular basis
  • Have pauses, gasps, and snorts and actually stop breathing.  The snorts or gasps may waken them and disrupt their sleep.
  • Be restless or sleep in abnormal positions
  • Sweat heavily during sleep

During the day, children with sleep apnoea may:

  • Have behavioural, school and social problems
  • Be difficult to wake up
  • Have headaches during the day, but especially in the morning
  • Be irritable, agitated, aggressive, and difficult
  • Be so sleepy during the day that they fall asleep or daydream

The problem is the same throughout the developed world where accurate figures are available. According to US Government Health Statistics, over quarter of a million children in the U.S.A. have tonsillectomies each year and sleep apnoea is one of the major reasons for this.

In Australia, extensive work has been done by The Royal Children’s Hospital in Melbourne, where there is a specialist children’s Sleep Unit. The problem is growing, mostly due to increased obesity, and they currently estimate that about 20 Australian children in every 100 will snore. OSA is less common and runs to about two to three children in every 100.

They state that children who have had surgery to remove their tonsils and adenoids may still need to return to the Sleep Unit afterwards. Most of the children will be cured by the surgery, but a few may still snore or have difficulty breathing when they are asleep.

A home sleep study run by Monash Health’s Melbourne’s Children’s Sleep Centre, is also testing whether children with simple snoring – but are not severe enough to have their tonsils or adenoids removed – have the potential to learn, but this is disrupted due to tiredness.

The figures in the UK are much higher, with 80% of 5 year olds now classed as overweight, which will often mean that they will be overweight as teens and adults too. As a result, it has been recommended that GP’s send them on lifestyle and weight management programmes run by local authorities.

Family members and Carers will also be encouraged to attend regardless of their own weight, as they have an important role and responsibility in influencing the environment in which children and young people live.

John Redfern