Child Snoring

Child snoring can affect up to 10% of the U.S. pediatric population. In the past, many children were considered to have “benign” snoring. This meant that there were no significant health consequences as a result of the snoring. However, leading pediatric airway experts now feel that there is usually some negative impact in most children that snore on a frequent basis. In fact, snoring has been strongly associated with a wide-range of detrimental effects on a child’s overall health and wellbeing- including a higher incidence of:

• Cognitive/behavioral problems
  • Depression/anxiety
  • Emotional reactivity
  • Poor school performance/ decreased ability to focus
  • Daytime sleepiness/fatigue
  • Allergies, asthma, and recurrent ear infections
• Increased blood pressure and other chronic heart/lung disorders
• Bed-wetting
• Obstructive sleep apnea
• Dental/orthodontic abnormalities

Causes of snoring in children?

Adenoids

are tonsil-like tissue found in the back of the nasal passage.

There are many factors that cause child snoring, including:

• • Swollen/enlarged nasal passages
  • Children with nasal allergies (also known as allergic rhinitis or hayfever) often have swollen nasal passages, that frequently contribute to persistent snoring.

• Enlarged adenoids and/or tonsils
  • In younger children, enlarged adenoids are one of the primary factors contributing to persistent childhood snoring. Adenoids can grow in size as a consequence of recurrent upper respiratory infections and nasal allergies. As the adenoids become bigger, the nasal passage becomes smaller and smaller. Peak adenoid size occurs between 2-6 years of age. Adenoid enlargement is one of the most common causes of mouth breathing in children. In fact, most children with frequent mouth breathing during the day and night will have enlarged adenoids. Enlarged tonsils are also a very important cause of childhood snoring. In combination, enlarged adenoids and tonsils can lead to significant snoring, mouth breathing, and even airway obstruction (referred to as obstructive sleep apnea).

• Obesity
  • Obesity is associated with snoring in children at or beyond puberty. Most younger children who snore on a frequent basis are not actually overweight.

What are the consequences that snoring can have on a child’s health and wellbeing?

• Although the answer to this question is very complicated, snoring frequently leads to disruption of sleep. Mouth breathing during sleep associated with snoring can interfere with the deep/restorative sleep that children experience when breathing through their nose. To help put this in perspective, think about the difficulty we have sleeping during the common cold. Although a child may not awake consciously from sleep, he/she may not be experiencing the deep sleep required for optimal daytime functioning.
• Detrimental effects can include increased incidence of:

• Cognitive/behavioral problems

• Depression/Anxiety
• Behavioral problems/ emotional reactivity
• Poor concentration/ school performance
• Attention deficit/hyperactivity
• Daytime sleepiness/fatigue

• Studies have shown that children with persistent snoring are up to 5 times more likely to have daytime sleepiness and up to 4 times more likely to have symptoms of attention deficit. Often times, treating a child’s snoring can lead to significant improvement in a child’s energy level, behavioral problems, and school performance.

Allergies / respiratory disorders linked to snoring

• Studies have shown that children with persistent snoring more frequently suffer from allergies, asthma, and recurrent ear/throat infections. A recent study showed that regularly snoring children with a history of asthma had more frequent and severe asthma symptoms than children that did not snore.

Child snoring and high blood pressure/chronic heart/lung disorders

• Childhood snoring has been shown to cause a small increase in blood pressure. The more severe the snoring and airway obstruction, the higher the blood pressure. This rise in blood pressure has been shown to have a negative effect on a child’s heart function and could potentially lead to chronic heart disorders as an adult.

Should I treat my child’s snoring?

The answer to this question is a controversial one and must be individualized for each child. When deciding when to treat childhood snoring, the physician must take a detailed medical history that assesses the following:

• Sleep history

A detailed sleep history is crucial. Signs that snoring may be associated with disrupted sleep include:

• Mouth breathing while sleeping
• Restless sleep
• Excessive sweating during sleep
• Frequent bed-wetting (out of proportion for age)
• Sleeping with head in unusual positions (hyper-extended or propped up with pillows)
• Gasping, labored breathing, or brief pauses in breathing

If any of these signs are present with snoring, your child may have a medical condition called obstructive sleep apnea.

• Daytime functioning

• Assessing for any abnormalities in daytime functioning is very important in determining how aggressively the snoring should be treated.

• Detailed physical examination
  • Children with snoring will frequently have swollen nasal passages that can be seen during the examination. Also, the physician can observe for mouth breathing in the office. Physician-diagnosed mouth breathing is one of the strongest predictors of adenoid enlargement. The tonsil size can be easily visualized during the examination as well. The jaw structure of the child is also important to assess. A narrow jaw structure and a lower jaw that is recessed (set farther back) can be associated with increased nasal obstruction and snoring.

• Over-night sleep study
  • Children with frequent snoring and issues with daytime functioning should be considered for an overnight sleep study (polysomnography). The sleep study will monitor the brain function (EEG), heart rhythm (EKG), oxygen levels, muscle movements, and snoring levels. Additionally, it will determine whether or not obstructive sleep apnea is present. Sleep apnea occurs when there is significant airway obstruction causing decreased quality of sleep. Children with persistent snoring are at increased risk of developing sleep apnea. The presence of obstructive sleep apnea would warrant more aggressive treatment of the snoring.

Studies have shown that children with persistent snoring are up to 5 times more likely to have daytime sleepiness and up to 4 times more likely to have symptoms of attention deficit.

How should my child’s snoring be treated?

Childhood snoring treatment should be customized depending on the medical history and findings on physical examination. Generally speaking, treatment can be considered as follows:

• Mild snoring without significant impairment in daytime functioning and no evidence of obstructive sleep apnea.
  • Identifying and treating nasal allergies s an important step for children with mild snoring and none of the signs of sleep disruption listed above. Nasal steroid sprays and anti-histamines can be helpful in many cases. Nasal steroid sprays can reduce the size of the nasal passage and adenoids. An allergist can perform skin testing to determine whether your child has significant environmental allergies contributing to snoring. Allergy shots and allergy drops (under the tongue) can also be very helpful in treating environmental allergies. Montelukast (Singulair), has also been shown to improve nasal congestion, decrease adenoid size, and improve snoring .

• Snoring associated with impairment in daytime functioning and/or evidence of obstructive sleep apnea
  • When children have snoring that is associated with impairment in daytime functioning and evidence of obstructive sleep apnea, more aggressive treatment should be considered.
    • Removal of the adenoids and tonsils should be considered the primary treatment option in this situation. Coordination of care between the pediatrician, allergist, and ENT (ear, nose and throat) surgeon is important to tailor care appropriately. It should be mentioned that there are other reasons to consider having the adenoids and tonsils removed in addition to snoring and obstructive sleep apnea.
• Identifying and treating nasal allergies is also an important step for children in this category.

• Children with significant snoring are also more likely to have orthodontic issues that can lead to nasal congestion, snoring, and obstructive sleep apnea. Many children with persistent snoring and mouthbreathing may have a narrow jaw structure and a recessed lower jaw (lower jaw set farther back). Early treatment of nasal allergies and adenoid/tonsil enlargement may reduce the frequency and severity of these jaw structure changes. A comprehensive evaluation by an orthodontist with knowledge of the developing pediatric airway is important for many children with persistent snoring.

Will my child outgrow the snoring without treatment?

Many children can outgrow their snoring over time. The peak incidence of snoring typically occurs at 6 year of age, corresponding with the peak growth of adenoid tissue. As the child’s airway develops beyond this age, the size of the airway can increase relative to the size of the tonsils and adenoids- resulting in diminished snoring. Whether to treat snoring aggressively must be determined by considering the risks and benefits of treatment.

Will treating child snoring lead to improved daytime functioning in my child?

While it is hard to predict the improvement in daytime functioning, many children have significant improvement in energy level, ability to focus, and experience an improvement in their health and overall wellbeing. While it is certainly the goal and hope of treatment, results cannot be guaranteed.

Child snoring diagnosis and treatment in Chicago

Dr. Rotskoff has been diagnosing and treating childhood allergies in Chicago since completing his fellowship in Allergy and Immunology at Children’s Memorial Hospital and Northwestern Memorial Hospital in 2003. He has developed a unique expertise in childhood snoring, nasal allergies, and obstructive sleep apnea. Dr. Rotskoff will work closely with your child’s pediatrician, Ear/Nose/Throat surgeon, and sleep specialist to help coordinate the most appropriate course of treatment.