Obstructive Sleep Apnoea is term that describes a disturbance to breathing when a child or adult is asleep.

Whether we breathe through our nose or our mouth (and our nose is more efficient and also humidifies the air we breathe in), air also has to go through our throat to get into and out of our windpipe and lungs. When we are awake, muscles in the neck hold the throat open. When we go to sleep, however, these muscles relax, and the throat becomes narrow.

Breathing through a narrow space usually makes some noise, which is why you can often hear someone breathing when they are asleep, but not often when they are awake. As the space gets narrower, the noise can become louder, and this becomes snoring. Snoring is very common in children and adults.

However, a proportion of people will have more difficulties. The space to breathe through may become so narrow that it takes a lot of effort to breathe. This makes people feel tired in the daytime. The space may become so narrow that it blocks any breathing completely. This is obstructive sleep apnoea. When the breathing is completely blocked, the oxygen level in the blood will begin to go down. This makes you wake up, and as you wake up, the muscles in your neck become more active, and the space in the throat to breathe through opens up. This then allows you to breathe again, the oxygen level becomes much better, and you fall deeper into sleep again, causing the muscles in the neck to relax, the breathing to be blocked, and so on.

Given that the blockage to breathing always causes the person to wake up again, OSA does not cause people to suffocate. However, constantly being woken up overnight means that the quality of sleep you get is not very good. This is something every parent will know!

This is important to children because if they don’t have good quality sleep, it makes it much more difficult to learn all the things they have to learn, it makes them more irritable and less patient when playing, and can also affect their general health. Everyone will know how they feel after a night with little sleep. In adults, it tends to make people sleepy in the day, and also affects their general health.

In children, OSA is usually caused by enlarged tonsils and adenoids, and is very effectively treated by an operation to remove the tonsils and adenoids. In adults, the condition is often associated with weight gain, and can be more difficult to manage.

To remove the tonsils and adenoids requires a general anaesthetic. The procedure takes about 30 minutes, but your child will be away from you for around an hour as it takes some time to wake up after the surgery. The main concerns with removing tonsils are the risks of pain and bleeding. In the worst cases this can mean coming back to hospital, and even possibly needing another operation. We can reduce this risk significantly, and make the operation much more comfortable, by only removing about 90-95% of the tonsils (a technique called coblation). Whilst this means that the tonsils can regrow, this is very rare.

There are a number of studies that have shown the benefit of tonsillectomy for children with OSA in improving the quality of their sleep (1), and consequently their quality of life (2), behaviour (3) and general health (4).



References:
​
1. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AG. Cochrane Database Syst Rev. 2015 Oct 14;(10):CD011165. 

2. Clinical assessment of pediatric obstructive sleep apnea. Goldstein N, Pugazhendhi V, Rao SM, Weedon J, Campbell TF, Goldman AC, Post JC, Rao M. Pediatrics 2004 Jul;114(1):33-43.

3. A randomized trial of adenotonsillectomy for childhood sleep apnea. Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R, Paruthi S, Muzumdar H, Gozal D, Thomas NH, Ware J, Beebe D, Snyder K, Elden L, Sprecher RC, Willging P, Jones D, Bent JP, Hoban T, Chervin RD, Ellenberg SS, Redline S; Childhood Adenotonsillectomy Trial (CHAT). N Engl J Med. 2013 Jun 20;368(25):2366-76. 

4. Inflammation and growth in young children with obstructive sleep apnea syndrome before and after adenotonsillectomy. Nachalon Y, Lowenthal N, Greenberg-Dotan S, Goldbart AD. Mediators Inflamm. 2014;2014:146893.