Need to know:

Snoring is the main symptom and sign of upper airway obstruction during sleep. Up to 14.8% of children snore ‘often’ as reported by parents, and obstructive sleep apnoea affects 1.2-5.7% of all children.^1,2 

Obstructive sleep apnoea (OSA) is defined by the American Thoracic Society as a “disorder of breathing during sleep characterised by prolonged partial or intermittent complete upper airway obstruction which impairs normal ventilation and sleep pattern”.³ However, in children the occurrence of repetitive apnoeas occurs at the severe end of the continuum of sleep disordered breathing. At the mild end, children can exhibit habitual snoring (snoring ≥3 nights per week) with no discrete apnoeas, gas exchange abnormalities or sleep fragmentation. It is important to diagnose and treat OSA as it is associated with adverse cardiological, neurological and behavioural effects.⁴ This article will review the pathophysiology, aetiology, risk factors and associated adverse outcomes of OSA in paediatrics and offer practical guidelines for managing these patients in the Australian primary care setting.

Snoring represents turbulent airflow and indicates partial airway obstruction. The upper airway collapses with the onset of sleep due to the loss of muscle tone during sleep compared to wakefulness. Additional anatomical narrowing of the airway can then lead to partial or complete airway closure. The greatest risk of apnoea is during REM sleep when muscle tone is lowest. Apnoeas during non-REM sleep are a marker of severe OSA apnoea in children.⁵