Paediatrics: Common presentation - snoring

Common presentation: snoring

We are concerned about snoring in children when it indicates that the child has obstructive sleep apnoea (OSA), i.e. snoring in association with periods of ineffective breathing lasting longer than 2 breaths (e.g. breathing at a rate of 20/min, this would be 6s). This is as opposed to central apneas, which are a pause >20s in an otherwise well child. The most common cause of OSA is Aden tonsillar hypertrophy. The other causes are as follows.

Differential diagnosis

Congenital anatomical

• Midface: e.g. hypoplasia in achondroplasia.
• Choanal atresia.
• Tongue: e.g. macroglossia in Beckwith syndrome, trisomy 21.
• Lower jaw: e.g. retro- and micrognathia.
• Syndromes: e.g. Pierre–Robin sequence, Treacher–Collins,Goldenhar, Apert.

Inflammation

• Adenotonsillar hypertrophy.
• Allergic rhinosinusitis.
• Nasal polyposis.
• Gastro-oesophageal reflux.

Masses

• Encephalocele.
• Nasal gliomas.

Central causes of pharyngeal hypotonia during sleep

• Cerebral palsy.
• Seizures.
• Hydrocephalus.
• Obesity

 Treatment

When snoring is associated with OSA, the underlying cause needs to be treated.