Snoring is the sound of obstructive sleep apnea. It is a sound everyone is familiar with. Both children and adults snore. It is the sound produced by the forced flow of air through a reduced space and is caused by partial or complete airway closure. The term used to describe this is increased airway resistance. As everyone knows snoring varies throughout the night. It increases during dream sleep (REM) and causes sleep disruption not just for the person who cannot fall asleep due to the loud snoring (“Snoree”) but more importantly for the person who is snoring (“Snorer”). The results of this obstruction include an increased effort of breathing and secondary oxygen, carbon dioxide exchange abnormalities and subsequent physiologic changes.
Common risk factors for obstructive sleep apnea include adenoid and/or tonsil enlargement, obesity, craniofacial abnormalities, Down syndrome, neuromuscular disorders including cerebral palsy, and a family history of obstructive sleep apnea. The most common clinical signs include loud snoring, apnea and gasping sounds. Sleep is often restless with frequent moving, thrashing or awakening. Another common complaint is excessive sweating. For the younger child weight loss or poor weight gain are often seen. Due to the sleep disruption daytime sleepiness is common as is decreased cognitive performance at work or school and an increased incidence of bedwetting. Grades can decrease and frequent complaints include hyperactivity, distractibility and overall attention problems. Many of these children are diagnosed incorrectly as having an attention deficit disorder (ADHD).
The diagnosis is made by history and observation. A sleep study (Polysomnography) can be obtained to verify the diagnosis. In this study heart rate and breathing patterns are monitored in conjunction with the oxygen level in the blood.
Treatment depends on the cause. The most common cause is adenotonsillar enlargement. In this situation a tonsillectomy and adenoidectomy is required. If obesity is the issue then weight loss is needed and continuous positive airway pressure may be prescribed to alleviate symptoms while pursuing a weight management program. For neuromuscular and congenital causes intervention is specific to the cause. Chronic obstructive sleep apnea can lead to systemic and pulmonary hypertension which must be prevented.
If your child or teen snores seek help and advice. Snoring is never normal. If the snoring is associated with an acute illness patience may be the treatment of choice. If it is chronic then a thorough evaluation and subsequent intervention are required.