Paediatric Snoring

Red Flags requiring urgent ENT review:

·       Children with breathing difficulties

ASsessment

History:

·       Duration

·       Pauses in breathing when asleep (apnoeas)

·       Affect on daytime function (tiredness, hyperactivity, focus, behavioural difficulties)

·       Prematurity, developmental milestones & nocturnal enuresis (children)

·       Related symptoms (tonsillitis, rhinitis)

Examination:

·       Mouth: Tonsillar hypertrophy, nasal airflow (misting on a metal object – adenoidal hypertrophy)

·       BMI

Sleep Disordered Breathing

Obstructive Sleep Apnoea (OSA) of Childhood: Obstruction of the upper airway occurs during relaxation of the pharyngeal muscles with adenotonsillar hypertrophy. Other neuromuscular or inflammatory (asthma, rhinitis) conditions can exacerbate the condition. There is some evidence that children with OSA can sustain long term health sequelae (neurocognitive, cardiovascular and metabolic) if not treated. OSA in children is also self limiting and resolves in most fit, well children as they grow. OSA may be more common in children due to rising rates of obesity.  

Children with a history suggestive of OSA should be referred to ENT routinely. The first line of management in children is adenotonsillectomy.

Referral Pathways 

Same Day Referral:

·       Children with difficulty breathing

Routine Referral

·       Children with a history suggestive of OSA to ENT

·       Adults with a history suggestive of OSA to respiratory or a sleep medicine specialist

More Information:

OSA in Children: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739955/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739955/

https://www.england.nhs.uk/evidence-based-interventions/interventions/

Author: Elliot Heward, ENT Registrar, North West Deanery