Sleep apnea in children | VivaRespire

Sleep Apnea in Children: Symptoms, Causes and Treatments

Sleep apnea is not exclusive to adults. It also affects children, often presenting differently with symptoms that can be overlooked or confused with other disorders. Early diagnosis is essential to prevent consequences on growth, cognitive development, and learning.

A widely under-diagnosed condition in children

The prevalence of obstructive sleep apnea in children is estimated between 1 and 5% of the pediatric population, with a peak between ages 2 and 8. Unlike adults, pediatric apnea is often caused by traceable anatomical causes - mainly enlarged tonsils and adenoids - and can often be treated definitively.

Symptoms very different from adults

A key diagnostic challenge is that children's symptoms differ considerably from adults'. Where adults present daytime sleepiness, children often react oppositely with hyperactivity and agitation.

Nighttime symptoms:

Regular loud snoring - main sign
Breathing pauses observed by parents
Mouth breathing and open mouth during sleep
Unusual sleep positions (head hyperextended to clear airway)
Excessive nighttime sweating
Bedwetting (nocturnal enuresis) - often overlooked as apnea symptom
Frequent awakenings, nocturnal agitation
Parasomnias (night terrors, sleepwalking)

Daytime symptoms:

Hyperactivity and agitation (paradoxical but characteristic)
School difficulties - concentration, memory, learning problems often confused with ADHD
Irritability and mood swings
Mouth breathing during the day
Growth delay in some cases

If your child snores regularly, sleeps with mouth open, and has unexplained school difficulties or hyperactivity, consult your pediatrician. Regular snoring in a child is never normal.

Severity thresholds in children

IAHO (child < 16 years)	Interpretation
< 1 /hour	Normal
1 to 5 /hour	Mild - ENT evaluation recommended
5 to 10 /hour	Moderate - treatment recommended
> 10 /hour	Severe - urgent treatment

An IAHO ≥ 1/hour in a child under 16 is considered abnormal. This threshold is much lower than in adults (where the normality threshold is < 5/hour).

Causes of sleep apnea in children

Enlarged tonsils: the main cause of pediatric apnea. Common between ages 2 and 8.
Enlarged adenoids: often associated with tonsil hypertrophy, obstructs the nasal passages and forces mouth breathing.
Maxillofacial malformations: receding jaw, narrow palate, large tongue.
Childhood obesity: growing risk factor with mechanisms similar to adults.
Down syndrome, neuromuscular diseases, repaired cleft palate, chronic allergies.

Treatments for pediatric sleep apnea

Surgery: first-line treatment in most cases

Adeno-tonsillectomy: effective and well-tolerated. Resolves or significantly improves apnea in 70-90% of cases. It is the most effective treatment for apnea caused by tonsillar hypertrophy.
Adenoidectomy alone: when obstruction is primarily from adenoids.

Orthodontic treatments

Palatal expansion: orthodontic device that widens the palate to improve nasal passage.

Pediatric CPAP

CPAP is used in children when surgery is insufficient or not possible: persistent apnea after adeno-tonsillectomy, surgical contraindication, obesity-related apnea, or neuromuscular diseases. Pediatric CPAP requires a mask adapted to the child's morphology and close follow-up.

Consequences of untreated apnea in children

Growth delay (deep sleep essential for growth hormone secretion)
Cognitive and academic difficulties (attention, memory, executive functions - often improve after treatment)
Behavioral problems (hyperactivity, ADHD-like behavior, aggression)
Maxillofacial development alterations from chronic mouth breathing
Hypertension even in children with severe apnea

For more information on CPAP options: CPAP reimbursement in Belgium. Browse our CPAP masks and CPAP devices.