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During sleep we breathe less deeply than when we are awake. If there are episodes when breathing actually stops, this is known as apnoea or an apnoeic episode. It may be caused by obstruction of the upper airways (obstructive sleep apnoea - OSA) or by a problem in the part of the brain which regulates breathing (central sleep apnoea). The difference between these can be determined by special sleep tests. OSA is frequently accompanied by snoring (but not everyone who snores has OSA!).
- Central Sleep apnoea: Congenital central sleep apnoea (Ondine’s Curse) is very rare (1 in 200,000 live births). It is due to a genetic abnormality and is usually apparent in the first days of life.
- Prader-Willi syndrome is another rare genetic disease in which there is marked obesity, OSA and central sleep apnoea, delayed development and small testicles,. It occurs in about 1 in 25,000 births.
- Obstructive sleep apnoea (OSA)
During sleep, repeated pauses in breathing (apnoeas), lasting more than 10 seconds, occur up to 100 times every night. Breathing is obstructed by the closure of the upper airway due to the abnormally relaxed muscles of throat and tongue. The result is snoring and repeated falls in blood oxygen levels which alert the brain to awaken the child, often with a loud snort. Breathing restarts and may be accompanied by flailing of arms and legs. Due to the frequent awakenings, the child is often tired and may fall asleep repeatedly during the day. OSA is quite common in middle-aged adults (4% men and 2% women) and is frequently related to obesity. It is also becoming increasing recognised in children, where the causes include a number of congenital conditions.
Causes of sleep disorders in children
Anatomical obstruction
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Reduced muscle tone
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Abnormal respiratory control
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| Obesity |
Down syndrome |
Central hypoventilation syndrome |
| Enlarged tonsils and adenoids |
Prader Willi syndrome |
Prader Willi syndrome |
| Down syndrome |
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| Achondroplasia |
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| Apert syndrome |
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| Crouzon syndrome |
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| Pfeiffer syndrome |
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| Sickle cell disease |
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| Mucopolysaccheridosis |
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| Marfan syndrome |
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Tonsils and adenoids are soft glandular tissues at the back of the mouth and nose. There are two tonsils, one on either side. The adenoids hang down from the back of the nose. They all form part of the immune system, defending the body from infection. In the past, removing enlarged tonsils and adenoids was common but today operation is only considered if special sleep study tests show evidence of OSA or if throat infections are very frequent and distressing.
- Obesity and Sleep-related disorders
- OSA. As in adults, obesity is a highly significant risk factor for OSA and the degree of OSA is related to the degree of obesity. As obesity becomes more common in children, so does OSA.
- Obesity Hypoventilation (Pickwickian syndrome); this may occur in some obese children who develop OSA but who also have inherited a reduced sensitivity to low blood oxygen and high carbon dioxide. OSA symptoms are greatly increased in these children.
- Sudden infant death syndrome
Sudden Infant Death Syndrome (SIDS), also known as cot death, features frequently in the media. About 300 babies still die of this every year. SIDS is the sudden unexpected death of an apparently well infant, for no obvious reason. The cause, or causes, of this very distressing problem are often unknown. 90% occur within the first 6 months of life. It is more likely in the premature or low birth-weight baby and is more common in boys than girls. Congenital abnormalities of breathing control may be the cause in some children, while in others there may be a familial link between SIDS and obstructive sleep apnoea. The likelihood of SIDS is increased when mothers smoke during and after pregnancy.
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