Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is a disorder in which your child’s breathing is partially or completely blocked during sleep repeatedly.

Obstructive Sleep Apnea (OSA)

Basic Information about OSA

Defined by the American Academy of Pediatrics (AAP) as a “disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns”.

  • Risk factors comprise
    • adenotonsillar hypertrophy,
    • obesity,
    • craniofacial anomalies, and
    • neuromuscular disorders

Occurs in 2% to 5% of children.

Primary snoring occurs in 12% to 20% of children

Physical findings

  • Frequent snoring (≥3 nights a week)
  • Labored breathing during sleep
  • Gasping or snorting during sleep
  • Pauses in breathing with sleep (apneic pauses)
  • Sleeping in a seated position or with the neck hyperextended
  • Daytime sleepiness
  • Headaches on awakening
  • Attention-deficit/hyperactivity disorder
  • Learning difficulties
Obstructive sleep apnea
Obstructive sleep apnea

Diagnosis and Evaluation

Providers should evaluate for snoring and signs/symptoms of OSA at each routine health supervision visit

If the child is having snoring or signs/symptoms of OSA, the provider should either obtain a polysomnogram or refer the patient to a sleep specialist or otolaryngologist for a further comprehensive evaluation.

Children with high-risk conditions for OSA

  • Children with high-risk conditions for OSA
    • craniofacial
    • metabolic
    • genetic
    • neuromuscular disorders
  • should be referred to a consultant (pediatric pulmonologist, otolaryngologist, or sleep medicine specialist)


Treatment of OSA

Adenotonsillectomy (T&A) is the first line of treatment in children with OSA or with adenotonsillar hypertrophy on physical examination (with no surgical contraindications)

T&A is often performed on an outpatient basis; postoperative inpatient monitoring should be performed for children with risk factors for postoperative respiratory complications (i.e., obesity or failure to thrive, younger than 3 years of age, severe OSA, craniofacial abnormalities, neuromuscular disorders, or current respiratory infection)

Providers should reassess OSA-related signs and symptoms 6 to 8 weeks postoperatively (to allow for healing of the operative site and recovery of the upper airway); in children with moderate-severe OSA, a repeat polysomnogram should be obtained 6 to 8 weeks postoperatively to evaluate for persistent OSA

Patients should be considered for referral for continuous positive airway pressure (CPAP) if OSA persists after T&A or if T&A is not performed.

Weight loss therapy should be proposed if the child is heavy or obese.

Watchful waiting with periodic retesting may be acceptable in select children with mild OSA and no significant sequelae, but T&A is recommended if there are significant symptoms or risk and in cases of moderate or severe OSA.

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