Symptoms and Consequences of Sleep Apnea in Children

The symptoms and consequences of untreated sleep apnea in children can be serious, affecting intelligence, behavior, and growth
Getty Images

Sleep apnea in a child occurs when the muscles of the upper airway relax enough to temporarily reduce or obstruct airflow. This can occur repeatedly over the course of a night and result in disrupted sleep as the brain attempts to awaken the body and resume normal breathing. Both events can be associated with a drop in blood oxygen levels.

In children, sleep apnea is prescribed when at least one apnea event occurs per hour of sleep as observed during a diagnostic sleep study. (For adults, more than five events per hour indicate apnea.)

Surprising signs of sleep apnea in children include mouth breathing, bedwetting, sleepwalking, restlessness, and sweating during sleep. There are also several potential consequences for a child's mental and physical health associated with sleep apnea.

How Common Is Sleep Apnea in Children?

Approximately 1% to 3% of preschool-aged children have sleep apnea. Apnea in children tends to peak between ages 2 and 6. Due to the course of normal growth during this period of time a child's tonsils and adenoids tend to be proportionately larger than their airway. This crowding makes the airway more easily obstruction.

The risk of sleep apnea also is higher in adolescents who are severely overweight or obese. Children of any age who have asthma or allergies also are more prone to developing sleep apnea.

Impacts of Sleep Apnea in Children

Sleep apnea may increase sleep fragmentation, meaning that rather than experiencing the normal periods associated with each sleep stage, a child with apnea moves more frequently between deep and lighter stages of sleep. Research suggests that the longterm effects of sleep apnea in children include cognitive, behavioral, and psychosocial problems as well as growth delays and impacts on cardiovascular health.

Problems With Intellectual Development

Children with untreated sleep apnea may perform poorly on standardized tests of mental development. In a school-based study in India, children with sleep apnea were found to perform significantly less well in academic subjects than their peers. Other potential problems with intellectual development include lower scores on learning and memory metrics and on some types of intelligence quotient (IQ) tests. Children with the most severe apnea appear to also experience the most significant challenges to cognitive development.

Hyperactivity and Other Behavioral Problems

Unlike in adults—who become sleepy and sedate with sleep deprivation—children tend to become hyperactive. This may cause difficulties with attention and social behavior and may also contribute to anxiety and depression. Hyperactivity resulting from sleep apnea in children sometimes is misdiagnosed as Attention Deficit and Hyperactivity Disorder (ADHD).

An English study in the Journal of Thoracic Disease also showed that children with untreated apnea were more likely to exhibit poor social and communication skills and have difficulty regulating their behaviors. These traits are often experienced by caregivers as uncooperativeness or emotional volatility.

Inflammation

When sleep apnea continues over a long period in childhood, increasing markers of inflammation can also be found. Inflammation, in turn, can lead to a cascade of negative health outcomes such as compromised organ function.

Sleepiness During the Day

A child who is not getting enough restorative sleep at night could show signs of excessive sleepiness during the day. Babies and children need different amounts of sleep based on their age and stage, but if you notice your child napping longer or more frequently than usual or seeming tired when he or she is normally energetic, apnea could be the cause.

Issues with Growth

Sleep-disordered breathing in children is associated with negative effects on growth. Children with apnea may lose ground among their peers, or slow along their previous growth path, resulting in an inability to meet their full growth potential. This may be caused by frequent awakening from deep, slow-wave sleep which in turn could disrupt normal hormonal secretion, including growth hormones. In extreme circumstances, a child with apnea whose growth falls far below healthy levels may be diagnosed with failure to thrive.

Risk of Cardiovascular Problems

If left untreated, sleep apnea in children can result in certain cardiovascular problems. These include issues with blood pressure regulation, hypertension, and other precursors to cardiovascular events. During vigorous exercise, it's also possible a child with untreated apnea will experience diminished cardiac performance.

The Evaluation and Treatment of Sleep Apnea in Children

Children whose caregivers believe they may have sleep apnea can be evaluated by a pediatric sleep specialist. Because home sleep apnea testing is not approved for use in children, this could require an overnight sleep study at a sleep center.

Treatment for sleep apnea in a children will be determined in large part based on the cause and may include allergy treatment, tonsillectomy, and an orthodontic protocol called rapid maxillary expansion. In some children, the use of continuous positive airway pressure (CPAP) machines may be helpful. As children grow closer to adult stature, other treatment options become available.

Sleep apnea can have serious, long-lasting consequences on mental and physical development. It's important to talk to your child's pediatrician or a pediatric sleep specialist if you have reason to believe that your child may be experiencing sleep apnea.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. El shakankiry HM. Sleep physiology and sleep disorders in childhood. Nat Sci Sleep. 2011;3:101-14. doi:10.2147/NSS.S22839

  2. Chiang, HK, Cronly, JK, Best, AM, et al. Development of a simplified pediatric obstructive sleep apnea (OSA) screening toolJ. Dental Sleep Med,. 2015;2, 163-173.

  3. Dehlink E, Tan HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis. 2016;8(2):224-35. doi:10.3978/j.issn.2072-1439.2015.12.04

  4. Goyal A, Pakhare AP, Bhatt GC, Choudhary B, Patil R. Association of pediatric obstructive sleep apnea with poor academic performance: A school-based study from India. Lung India. 2018;35(2):132-136.

  5. Hunter SJ, Gozal D, Smith DL, Philby MF, Kaylegian J, Kheirandish-gozal L. Effect of Sleep-disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-aged Children. Am J Respir Crit Care Med. 2016;194(6):739-47. doi:10.1164/rccm.201510-2099OC

  6. Tsukada E, Kitamura S, Enomoto M, et al. Prevalence of childhood obstructive sleep apnea syndrome and its role in daytime sleepiness. PLoS ONE. 2018;13(10):e0204409. doi:10.1371/journal.pone.0204409

  7. Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):e714-55. doi:10.1542/peds.2012-1672

Additional Reading