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Obstructive sleep apnea is the most serious of a group of conditions associated with abnormal sleep and called sleep disorders. Disturbed sleep is observed in adults, but also in children.

In children, the mildest sleep disorder is snoring and affects up to 12% of children of all ages, while 2-4% present symptoms of obstructive sleep apnea. Obstructive sleep apnea in children is characterized by repeated episodes of upper airway obstruction only during sleep. The flow of inhaled air from the nose and pharynx is interrupted (apnea) or reduced (hypopnea), while thoracic and abdominal respiratory effort continues.

To understand the importance of snoring, the following should be emphasized.

In adults, snoring, when isolated, i.e. without accompanying findings of apnea, is not considered a sleep disorder. Conversely, in children, its presence indicates an underlying pathological obstruction in the respiratory system, is registered as a 1st degree sleep disorder and requires evaluation by an Otolaryngologist.

The cause in the vast majority of children 2-8 years old who snore with or without apnea is hypertrophy of the tonsils or adenoid buds (commonly called lobules) or a combination of both. Other less common causes are a small lower jaw, a large tongue, childhood obesity, syndromes with craniofacial abnormalities and/or neurological problems and benign tumors of the nasopharynx.

A child with obstructive sleep apnea may have behavioral problems, attention deficits, and learning disabilities due to poor sleep quality. Also, due to chronic hypoxia, they may have developmental delays, while permanent mouth breathing leads to abnormal dentition and development of the upper or lower jaw, which is why a respiratory disorder is often suspected by a pediatric dentist or orthodontist who will examine a child for a purely dental issue. The most serious chronic complication is pulmonary hypertension, a disease of the cardiac system.

Children of all ages with obstructive sleep apnea, but especially the youngest, often have daytime respiratory distress, which manifests itself in reduced endurance when running or simply walking, or even noisy breathing during hours when the child is playing sitting down or is focused, for example, on the television.

The test for hypertrophy of tonsils and adenoids and generally the entire upper respiratory system is performed by clinical examination in the otolaryngology clinic.

The most modern method for assessing the size of the adenoids and the degree of airway obstruction in the clinic is endoscopy of the airway with an optical fiber through the nose, which is painless and therefore does not require local anesthesia, lasts only a few seconds, but through the possibility of video recording there is the possibility of repeated analysis of the findings and finally, it eliminates the need for x-rays for adenoids (meats) and the radiation that this entails.

The information provided by parents with their own video of a few minutes of the child sleeping often proves useful. In doubtful or borderline cases regarding the severity of symptoms, a sleep study is recommended, i.e. a simple overnight stay of the child in the hospital to measure parameters such as oxygen saturation, heart rate, etc. that will prove the existence and severity of apneas.

Obstructive sleep apnea in children is mainly treated by removing the tonsils and adenoids, and the rates of complete cure in children without other health problems are close to 99%.

It is interesting that the international scientific community related to this condition (otolaryngologists, pediatricians, pulmonologists) only in the last 20-30 years began to realize the immediate and mainly the long-term consequences of a chronic obstructive condition. Characteristically, in previous years, tonsil removal was mainly performed in children and adults with frequent episodes of inflammation.

However, it has been observed that children with apnea due to hypertrophic tonsils in most cases have few to no episodes of tonsillitis, therefore these children remained mostly untreated.

It is now strongly recommended to treat a child with apnea immediately rather than later, regardless of age, which is why surgery is currently encouraged in infants from the age of 18 months and older, and waiting until they are older is considered a wrong choice.