GPAtlas🧭 When to suspect
Obstructive sleep apnoea (OSA) in children sits on a spectrum of sleep-disordered breathing that runs from harmless primary (simple) snoring through to true OSA.
• Primary snoring affects roughly 12–15% of children.
• In OSA, repeated upper-airway collapse during sleep causes apnoeas and fragmented, non-restorative sleep.
• OSA affects about 1–2% of children and, unlike in adults, occurs equally in boys and girls.
Suspect OSA in any child who snores regularly when otherwise well, particularly alongside:
• Witnessed pauses
• Gasping or choking
• Restless sleep
• Daytime behavioural and concentration problems
There are two characteristic peaks:
• A common preschool peak (roughly 2–6 years) driven by adenotonsillar hypertrophy
• A second peak in older children and adolescents related to obesity
In primary care, aim to:
• Distinguish simple snoring from OSA
• Recognise the daytime behavioural impact
• Refer the right child by the right route – ENT for uncomplicated adenotonsillar disease, paediatrics for the child with comorbidities
| Feature | Primary (simple) snoring | Obstructive sleep apnoea |
|---|---|---|
| Snoring pattern | Habitual snoring, but no witnessed pauses | Loud snoring with witnessed pauses, gasps or snorts |
| Oxygen desaturation | None | Episodic dips in oxygen during sleep |
| Daytime effects | None of significance | Behavioural problems, poor concentration, ± sleepiness |
| Approximate prevalence | ~12–15% of children | ~1–2% of children |
| Action | Reassure and safety-net | Refer for specialist assessment |
|
🧠 Clinical pearl • In children, OSA more often shows itself as daytime hyperactivity, inattention and behavioural problems – mimicking attention deficit hyperactivity disorder (ADHD) – than as the classic adult pattern of daytime sleepiness. • Always ask about sleep and snoring before settling on a behavioural label. • Remember that, in children, obstructive events cluster in rapid eye movement (REM) sleep rather than across all sleep stages. |
Source: ENT UK
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