Obstructive sleep apnea & tonsils
Obstructive sleep apnea in normal children is almost always caused by enlarged (hypertrophic) tonsils and adenoids). These children will display the typical sleeping patterns of sleep apnea. They have loud snoring, frequent pauses with breathing at night, frequent awakening from sleep, restless sleep, nightmares, and bedwetting (enuresis). During the daytime, these children are mouth breathers, may have excessive daytime sleepiness, and poor school performance.
Other more rare causes of sleep apnea include any congenital (present from birth) or acquired cause of upper airway obstruction.
The treatment of obstructive sleep apnea is directed to the cause of the obstruction.
As noted above, most cases of obstructive sleep apnea in children is caused by enlarged tonsils and adenoids. Surgical interventions are therefore directed to what is causing the obstruction. In the case of enlarged tonsils and adenoids, tonsillectomy and adenoidectomy is usually successful in relieving the problem. If the problem is not the tonsils and adenoids, the cause of the obstruction must be determined. For example, surgery of the jaw may be required. In some cases, even a tracheostomy is necessary. Non-surgical therapies include oral prostheses (difficult in children), medications (steroids, stimulants), and weight reduction.
In almost every case of obstructive sleep apnea in children who do not have unusual anatomic problems, tonsillectomy and adenoidectomy is a safe and effective treatment, and is highly recommended.