Craig Canapari, MD, a MassGeneral Hospital for Children pulmonologist and sleep expert, answers questions about the American Academy of Pediatrics’ revised sleep apnea guidelines, which say all children and teens who frequently snore should be evaluated for obstructive sleep apnea (OSA), all children with OSA and enlarged tonsils should consider having their tonsils removed, and all children who undergo tonsil removal surgery should be re-evaluated for sleep apnea and consider alternate treatments if their condition has not improved.

When Is My Child’s Snoring a Problem?


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Why has the American Academy of Pediatrics (AAP) revised its sleep apnea guidelines?

In the past 10 years, a significant amount of research has demonstrated the relationship between OSA and multiple childhood health problems. Children can have behavioral issues, school performance problems, daytime sleepiness and high blood pressure if OSA is left untreated. In the new policy statement, they have recommended clinical evaluation for persistent snoring or other signs of OSA. If the diagnosis is unclear, an overnight sleep test (or polysomnogram) is recommended. This is the only test which can rule out OSA.

When should I bring my child to the doctor for sleep apnea?

You should see a sleep specialist if your child has any of the following:

  • If your child regularly snores (more than 3 nights per week)
  • If your child has sleep disruption (is waking up in the middle of the night)
  • If it’s difficult to wake an elementary school aged child in the morning
  • If your child has difficulties at school because he is sleepy.

How common is sleep apnea in children? 

Between 1 to 5 percent of kids have OSA, which doesn’t sound like a lot, but in reality that means 1 in 20 kids at a pediatrician’s office has OSA. Thirty-three percent of obese kids will have OSA, and the percentage is higher if they snore. Unfortunately, OSA is becoming more and more common in the context of the obesity epidemic.

Craig Canapari, MD

What are the treatment options for sleep apnea?

The AAP recommends adenotonsillectomy as the first line treatment in any child with OSA and enlargement of the tonsils and adenoids. A lot of parents are worried about the surgery, but it is actually quite safe and the benefits are significant. In some kids, however, there is residual OSA after surgery. Thus, all children with OSA who have surgery need to be followed up to see if their symptoms resolve and to make sure that they do not return. If symptoms persist, a sleep study may be helpful. Alternative treatments are available if sleep apnea persists. Weight loss will help in obese kids, and allergy treatments, intranasal steroids, orthodontic work, and continuous positive airway pressure (CPAP) can benefit some kids.


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