A child who snores

Physiological hyperplasia of the adenoids and tonsils occurs between the ages of approximately 18 months and 6 years. As a result, snoring is very common in young children. • Comorbidities such as Down syndrome, micrognathia, and craniofacial syndromes are commonly associated with a degree of upper airway obstruction, and these children are more at risk of significant obstructive sleep apnoea. Children with a repaired cleft palate are at risk of velopharyngeal insufficiency if the adenoids are removed. • Obesity is less common as a cause of snoring in children than in adults but is increasing in prevalence • Coexisting ear, nose and throat problems such as hearing impairment, ear infections and sore throats can influence the decision to proceed to surgery. • Evidence of obstructive sleep apnoea (OSA). This is the key issue. The most useful predictor of OSA in clinical practice is a history of heavy snoring with disturbed sleep, respiratory pauses and snort arousals. OSA may be associated with night terrors and enuresis. Daytime fatigue is rare in children because they return much more quickly to the refreshing, deep levels of sleep (stages 3 and 4 slow wave sleep) after each episode of arousal: poor sleep quality leads paradoxically to hyperactivity and behavioural problems. Difficulties with concentration and learning ensue – a large number of observational studies have shown an association between sleep disordered breathing and measures of hyperactivity, inattention, problem behaviour and poor cognitive function, although long-term studies are absent. Pulmonary hypertension and cor pulmonale are late effects in severely affected children and are rare, except in children with an underlying disorder such as Down syndrome.