Common Questions for Snoring on Children in Singapore

While snoring is most common amongst older adults, the phenomenon is not uncommon among children in Singapore. Research shows that 20% of normal children occasionally snore and between 7% to 10% habitually snoring. In most cases, however, snoring is not a cause for concern. Only about 1% of children snore as a result of sleep and breathing problems, but knowing how to identify a sleep-related breathing issue is key to avoiding potential detrimental effects on your child.

Snoring once or twice a week without any noticeable symptoms or associated health issues is considered normal. But when snoring becomes more frequent and interrupts sleep, it can point to a sleep-related breathing disorder, otherwise called Obstructive Sleep Apnea Hypoventilation Syndrome (OSAHS).

What causes Children to Snore? 

During sleep, your child’s muscles, including the muscles that support breathing, become more relaxed than during their waking hours. In some children, these muscles relax to a point where the airway narrows and eventually closes, causing lapses in your child’s breathing. As a result, your child may gasp for air or snort as they snore. These lapses may occur dozens of times throughout the night, and sometimes awaken your child momentarily even though your child might not remember waking up to catch his breath.

A few factors cause the airway to narrow. This includes:

• Enlarged tonsils and adenoids that can cause blockage in the airway and hence, a narrow airway for air to pass through
• Abnormalities in the jaw and face area resulting in a natural obstruction in the airway
• Children with low muscle tone in the mouth and upper airway, as seen in the case with many children with Down Syndrome

Studies have also found that obesity, cold-like symptoms, allergies, and asthma can narrow the airway.

When should I be concerned about my Child’s Snoring? 

Many children snore at some point in their lives, especially during bouts of cold and allergies. Here are some indications that you should take your child’s snoring more seriously:

• Snoring three or more times a week
• Gasping for air or difficulty breathing while sleeping
• Irritable or cranky 
• Frequently wetting the bed, especially if this never or rarely happened before 
• Daytime fatigue
• Behavioural issues or difficulty concentrating
• Below-average weight gain
• Bluish skin

Risk factors that cause Children to Snore 

Certain factors tend to increase the likelihood of OSAHS:

• Gender: In children, boys are more likely to suffer from OSAHS — a similar pattern is observed in adults.
• Breastfed: Children who are not breastfed tend to suffer from OSAHS, likely because breast milk provides immunologic protection against infections that promote OSAHS and this protection is absent in children who are not breastfed.
• Obesity: Weight is significantly related to OSAHS in children. Children who are heavier are more susceptible to suffer from OSAHS.
• Enlarged tonsils and adenoids: Hypertrophy of the tonsil and/or adenoids causes blockage in the upper airway. Combined with other factors e.g. reduced muscle tone as observed in children, this can lead to a clinically significant obstruction in the airway during sleep.
• Physical features: There are children born with narrow airways.
• Family history: It is more likely for your child to suffer from OSAHS if this condition is present in your family history.

How is Snoring in Children diagnosed in Singapore? 

Diagnosing OSAHS in children is often more difficult than diagnosing sleep apnoea in adults. This is because the symptoms are more subtle and children may not be able to adequately express themselves to explain how they feel.

To determine the severity of the condition, your doctor may order an in-patient sleep study to monitor your child overnight. During this study, sensors are used to track your child’s heart rate, breathing and oxygen levels, and brain activities. It is possible for this study to be executed in the comforts of your home but the diagnosis would be less clear due to the limitation of the environment.

How is Snoring in Children treated? 

The treatment of snoring is broadly categorised into medical and surgical options. A staged approach is often adopted in which medical therapy is applied first, followed by consideration of surgery.

• Medical: As OSASH is caused by obstruction in the airway, your doctor may recommend Nasal continuous positive airway pressure (CPAP) therapy. This involves wearing a nasal mask to supply steady flow of air to the oxygen. Besides therapy, your doctor may also prescribe medication to help your child breath through his nose during sleep.

• Surgical: Surgical treatment may be considered, depending on the location of the tissues contributing to snoring. Some patients have extra tissue in the throat, which when removed may alleviate snoring. There is also another procedure that stiffens and shrinks the tissues of the soft palate, which can also be used to treat snoring.