Kids who snore should be evaluated for sleep apnoea. That's the main recommendation that comes from a set of updated guidelines released by the American Academy of Pediatrics.
"The evidence is much stronger today," said Dr Carole Marcus, a professor of paediatrics at the Children's Hospital of Philadelphia. "Paediatricians should routinely ask parents about snoring, but if they don't, parents should bring it up," she said. "Snoring in kids can be a sign of a serious medical illness."
Marcus was referring to sleep apnoea, which is marked by pauses in breathing that occur throughout the night and disrupt sleep. When left untreated, sleep apnoea in children can result in behavioural and learning difficulties and may also affect growth. These consequences are largely related to lack of quality sleep.
How the study was done
Researchers led by Marcus reviewed studies on diagnosis and management of sleep apnoea in kids published between 1999 and 2011, most of them appearing after the last set of guidelines were released in 2002. The new guidelines are published in the journal Pediatrics.
If a child snores, paediatricians need to follow-up with a thorough history and exam, she noted. "If this all points to sleep apnea, then get a sleep study," Marcus said. The gold standard for diagnosing sleep apnea is a formal sleep study, but this is not always possible for young children because it involves sleeping in a laboratory environment away from home. Other options may include a home sleep study where children are hooked up to a monitor in the comfort of their regular bedroom, or asking parents to videotape the child during what they believe may be an apnoea episode.
Many children with sleep apnoea have enlarged tonsils and adenoids. In these kids, removing tonsils and adenoids may cure the sleep apnea. Other treatments include positive airway pressure (PAP) machines to help keep the airways open during sleep. Some medications may also help treat sleep apnoea.
Dr Michael Rothschild, the director of paediatric otolaryngology at Mount Sinai Medical Center in New York City, agreed that kids who snore should be screened for sleep apnea. "If the child snores, but has small tonsils and I get a good history from parents, and they show no signs of struggling when I watch a video of them at night, I feel comfortable that this is just uncomplicated snoring," he said. "Not every kid who snores needs surgery."
And surgery alone doesn't cure every kid with sleep apnea, Rothschild added. Obesity is on the rise among kids, and is linked to sleep apnoea. "There are obese kids with small tonsils and thin kids with big tonsils," he said. In obese children, weight loss is also part of the treatment plan as surgery alone may not resolve the sleep apnea entirely.
The guidelines recommend weight loss in obese or overweight children who snore, in addition to other therapy.
Tips for better sleep
Get the facts about sleep apnea from the U.S. National Heart, Lung, and Blood Institute.
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