April 2, 2002 -- Children who snore may have obstructive sleep apnea, a serious and underdiagnosed disorder that can lead to learning problems, growth retardation, and even heart and brain damage. In light of this, the American Academy of Pediatrics has developed guidelines to help pediatricians recognize and treat the condition before serious health problems occur.
The AAP estimates that 2% of preschool children have snoring associated with sleep apnea, which is most often caused by enlarged tonsils and adenoids. In untreated children, the condition may lead to irreversible neurologic problems, says child sleep expert Carole L. Marcus, MBBCh, chairperson of the AAP guidelines committee.
"This is a common problem among children, with potentially serious consequences," Marcus tells WebMD. "But many parents don't even bring up snoring with their child's pediatricians, and pediatricians don't typically ask about it. One reason for the guidelines is to make both parents and pediatricians aware of it." Marcus is director of the pediatric sleep center at Johns Hopkins University in Baltimore.
The AAP guidelines call on pediatricians to ask about snoring during routine checkups. While not all children who snore have associated health problems, physicians are urged to take a thorough sleep history of patients who do.
Children who snore nightly and also have behavioral, learning, or health problems that might be related to their snoring should be referred to a sleep lab for overnight study. Surgical removal of the tonsils and adenoids is the first line of treatment for the majority of children who have obstructive sleep apnea. Roughly 95% of pediatric patients can be cured with this surgery, Marcus says.
While as many as one in 10 children snore nightly, pediatric sleep researcher David Gozal, MD, says it is not clear how many of them have health problems associated with snoring. Current estimates suggest that one in five children who snore have obstructive sleep apnea, but many more than that may have unrecognized snoring-related problems, he says.
"Snoring is not normal. No child should snore," Gozal tells WebMD. "But it is true that some children appear to have no health problems associated with it. I think as we learn more, we will find that more children have problems than we realize."
Some children who have been diagnosed and are being treated for attention deficit hyperactivity disorder (ADHD) may actually have sleep apnea. Sleep deprivation in children with apnea often manifests as hyperactivity, Gozal says. This is often misunderstood by parents and teachers, and misdiagnosed by doctors.
Gozal is currently studying sleep apnea in children as director of the University of Louisville's Kosair Children's Hospital Research Institute. His earlier research suggested a link between untreated sleep apnea and potentially permanent learning problems. One theory is that children with the condition experience oxygen deprivation to the brain during sleep, which can lead to brain damage.
"The main message is that a child who is snoring needs to be evaluated," Gozal says. "And if there are any other problems that may be associated with it, that is a red flag that something is wrong."