Obstructive sleep apnoea (OSA)

  • Obstructive sleep apnoea (OSA) is a medical condition that involves breathing difficulties in children when they are asleep. When children (and adults) fall asleep, their muscles relax. This includes muscles in the upper airway, which can become either partly or totally blocked by the adenoids and tonsils in sleeping children. You may notice snoring and pauses in your child's breathing while they are sleeping.   

    Snoring in children is quite common – about 15 to 20 per cent of children snore. OSA is less common, and only affects about two to three per cent of children.

    OSA disrupts sleep. If your child has OSA, they may feel tired in the day, and they may have learning, behavioural and/or medical problems.

    Signs and symptoms of childhood OSA

    If your child has OSA, you may notice that your child:

    • has loud snoring, pauses in breathing and difficulty breathing during sleep
    • chokes, gasps or snorts in their sleep
    • is restless and sweaty while asleep
    • sleeps in unusual positions, e.g. propped up high on pillows 
    • breathes through their mouth instead of their nose at night 
    • has headaches and/or is tired in the morning
    • has a blocked nose, poor appetite and/or problems swallowing.

    Sometimes, the only problems that a child with OSA may show are difficulties with paying attention, behavioural problems and learning difficulties. 

    What causes childhood OSA?

    The most common cause of OSA in childhood is enlargement of the tonsils in the back of the throat, adenoids in the back of the nose, and turbinates (small bony structures) in the breathing passage. Tonsils and adenoids grow most quickly between the ages of two and seven years old. Having the tonsils and adenoids taken out cures OSA in 80–90 per cent of children. Sometimes, the adenoids grow back again. If the symptoms return, your child may need more surgery.

    Other causes of OSA include: 

    • obesity
    • long-term allergy or hay fever
    • certain medical conditions associated with weak muscles or low muscle tone, such as Down syndrome
    • very small jaws or flat faces in children.

    When to see a doctor

    If you suspect your child has OSA, take them to see your GP. Your child may be referred to a paediatrician, or ear, nose and throat specialist. The doctor may suggest your child has overnight monitoring, either in hospital or at home. This may help diagnose OSA.

    Treatment for OSA

    Once the diagnosis has been made, treatment depends on what is causing the problem and how serious it is. 

    • Children who have enlarged adenoids and tonsils may need to have surgery to take them out. 
    • Children who are very overweight will need to start an exercise and weight-management program. 
    • Children with long-term (chronic) nasal allergy may trial a mix of different medical treatments. Your doctor will discuss these with you if necessary. 
    • Children with special conditions or severe sleep apnoea may need a Continuous Positive Airways Pressure (CPAP) machine to help them breathe at night.  
    • There are a few children who will need more specialised surgical procedures.


    Children who have surgery to remove their tonsils and adenoids may need to come back to the sleep clinic after the surgery. This might be the case if their sleep study showed severe OSA or if their symptoms do not get better six to eight weeks after the surgery.

    Although most children will be cured by the surgery, a few may still snore or have difficulty breathing when they are asleep. If your child is still showing symptoms of OSA, tell your doctor. Your child may need some more tests or treatment.

    Key points to remember

    • Loud snoring, pauses in breathing and difficulty breathing during sleep are signs that a child has obstructive sleep apnoea (OSA).
    • Children with OSA may feel sleepy in the daytime, have learning difficulties, behaviour problems or medical problems.
    • Overnight monitoring at home or in hospital may help to diagnose OSA.
    • Most children will be cured by removal of the tonsils and adenoids.

    For more information

    Common questions our doctors are asked

    If my child snores, is she likely to develop OSA?

    No, it isn’t likely – up to 20 per cent of children snore but only around three per cent have OSA. Snoring is just one of the signs of OSA – if your child has OSA they are likely to also have pauses in their breathing or snorts and gasps while they sleep, as well as daytime sleepiness from disrupted sleep overnight.   

    If my child has learning difficulties or behavioural problems, should I ask for a sleep study?

    There are many possible causes for learning difficulties or behavioural problems in children, and OSA is just one of these. If your child is having learning or behavioural problems, your GP may refer you to a paediatrician, who will examine your child and investigate the cause of their problems.

    Developed by The Royal Children's Hospital Centre for Community Child Health Sleep Clinic. We acknowledge the input of RCH consumers and carers. 

    Reviewed March 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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