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Obstructive sleep apnea syndrome (OSAS) is a relatively common problem in children with an estimated prevalence of 1% to 10%. The most common underlying cause of OSAS in children is enlargement of the tonsils and adenoids. Other underlying conditions that may predispose children to developing OSAS include obesity, craniofacial abnormalities, and certain neuromuscular disorders.

The most common symptom of OSAS in children is snoring. Parents may also notice certain symptoms while the child is asleep including mouth breathing, restlessness, and episodes of sleep apnea (cessation of breathing). The potential complications of untreated OSAS in children include growth disturbances, attention deficit disorder, behavioral problems, and bedwetting.

The diagnosis of obstructive sleep apnea syndrome (OSAS) in children is based upon the patient history (signs and symptoms) and physical examination. This is usually sufficient to establish the diagnosis in a child with signs and symptoms of OSAS who also has enlarged tonsils and adenoids. Polysomnography (overnight sleep test) may be necessary to confirm the diagnosis in children with signs and symptoms of OSAS but without enlarged tonsils and adenoids.

Surgical removal of the tonsils and adenoids (adenotonsillectomy) is usually the first-line treatment for OSAS in children when the physical examination reveals enlargement of the tonsils and adenoids. This type of surgery is very effective in children and usually eliminates or significantly reduces the signs and symptoms of OSAS.

Other types of surgical procedures that may be used in children with OSAS include:

• Uvulopalatopharyngolasty (UPPP) - This procedure involves surgically excising excess tissue at the back of the throat, parts of the soft palate, and the uvula.

• Maxillofacial surgery - Children with cranifacial abnormalities who suffer with OSAS usually require maxillofacial surgery (e.g., maxillomandibular advancement; genioglossal advancement) to correct the underlying cause of the upper airway obstruction.

For children without obvious anatomical abnormalities who do not require surgery, continuous positive airway pressure (CPAP) therapy has been found to be an effective treatment. A CPAP machine is a device that consists of a fan blower, a face mask , and a flexible tube that supplies a continuous flow of air from the fan blower to the patient through the mask. The creation of continuous positive airway pressure prevents collapse of the upper airway during sleep throughout the respiratory cycle. Approximately 1 out of 5 children experience difficulty with CPAP therapy, particularly in tolerating the air pressure. Compliance with CPAP therapy is crucial for obtaining the maximum benefits of this treatment modality and, therefore, parents must be vigilant in informing their doctor when any problems develop during CPAP therapy that result in reduced compliance.

A weight loss program should be recommended to children with OSAS who are obese since weight loss can help to significantly control symptoms of OSAS in both children as well as adults. Nasal sprays containing a medication (e.g., steroid) may be used temporarily to improve symptoms of nasal congestion.