Q: My child snores while sleeping. Should I be worried?

Snoring during sleep is fairly common in children. As many as 15 in 100 children will have some snoring during sleep.

Just because snoring is common doesn’t mean that you never have to worry about it. Snoring can be a symptom of sleep apnea, a more serious underlying problem that can affect your child’s physical and mental well-being.

Sleep apnea refers to a narrowing of the throat during sleep and is associated with difficulties moving air in and out of the lungs. This in turn leads to disrupted and poor sleep and in more severe cases can lead to drops in the blood-oxygen level.

Like ice cream, sleep apnea comes in different flavors. Sleep apnea can be broken down into mild, moderate and severe apnea. Most children have mild to moderate sleep apnea.

Some children don’t make the classic adult snoring noise with pauses in breathing, but they can still have significant apnea.

Following is what you need to know about kids and snoring.

Signs and symptoms that should make you more concerned about your child’s snoring:

  • Loud snoring.
  • Pauses in breathing and gasping noises.
  • Breathing with mouth open throughout the night.
  • Breathing that looks uncomfortable. For example, the chest is not moving        smoothly and easily.
  • Your child is very restless and tosses and turns during sleep.
  • Your child has risk factors that increase the likelihood for sleep apnea.
    –       Obesity
    –       Premature birth
    –       Any surgery on the face or airway
    –       Down syndrome
    –       Abnormal muscle weakness
    –       Chronic medical illness

Consequences of sleep apnea:

  • Your child looks like he/she had a poor night’s sleep.
  • Your child is hard to wake up and cranky during the day despite getting the age appropriate amount of sleep.
  • Your child has decreased energy or seems to look tired or falls asleep unexpectedly at home or at school.
  • Your child’s school performance deteriorates without any other clear cause.
  • Your child may have difficulty gaining weight.

* Please note: some children with severe sleep apnea do not have obvious sleepiness or behavior problems.

Sleep apnea diagnosis:

  • First, you must think about it when hearing your child snore and watching him/her sleep.
  • Discuss your concerns with your child’s pediatrician.
  • It can be very helpful if you record a few minutes of snoring with a camera or cell phone and show the video to the pediatrician.
  • Your pediatrician will also examine your child to see if he/she has enlarged tonsils.
  • If the tonsils are very large, the pediatrician might refer you directly to an ear nose and throat (ENT) specialist to see if your child is a candidate for surgical removal of the tonsils and adenoids (tissue that sits in the back of the nose).

When to see a sleep specialist for further evaluation:

  • If the pediatrician thinks that a direct referral to the ENT doctor is not indicated.
  • If your child has already been treated for sleep apnea but still snores or has poor sleep.
  • If your child has the following risk factors:
    – Age younger than 3 years.
    – Does not have obviously enlarged tonsils.
    – You are not comfortable proceeding with surgery without further objective evaluation.
    – Your child is obese.
    – Your child has Down syndrome.
    – Your child has sickle cell disease.
    – Your child has a bleeding disorder.
    – Your child has a chronic medical condition that increases the risk for surgery.

What to expect from the sleep specialist:

  • Doernbecher has a multidisciplinary team with three highly trained sleep specialists who are board-certified in sleep medicine. We have backgrounds in General Pediatrics, Pediatric Psychiatry and Pediatric Pulmonology.
  • We will take a thorough history and perform a physical examination. After gathering all the important information, we will discuss with you whether further testing is needed.
  • The standard test for sleep apnea is an overnight sleep study.
  • The study is performed at the Marriot Hotel at the Riverfront and not at the hospital. This provides a comfortable environment for the kids and parents.
  • The test typically starts around 8 p.m. and ends around 6 a.m. One parent will stay with the child for the night.
  • The sleep study allows us to monitor changes in breathing, oxygen levels, sleep quality, heart rate and leg movements every second for the whole night.
  • The sleep specialist will review the study carefully and then discuss the findings and treatment recommendations with your family.

Holger Link, M.D., M.R.C.P.
Assistant Professor of Pediatrics, Division of Pulmonary Medicine
OHSU Doernbecher Pediatric Sleep Disorders Clinic