Q&A: Obstructive Speep Apnea

Sleep apnoea is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times a night.

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In this article:
What is obstructive sleep apnoea?
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

What is obstructive sleep apnoea?

Sleep apnoea may be either obstructive sleep apnoea (OSA) in which breathing is interrupted by a blockage of air flow, central sleep apnoea (CSA) in which regular unconscious breathing simply stops, or a combination of the two. Obstructive (OSA) is the most common form.

Risk factors for OSA include being overweight, a family history of the condition, allergies, a small breathing airway, and enlarged tonsils. Some people with sleep apnoea are unaware they have the condition. In many cases it is first observed by a family member. Sleep apnoea is often diagnosed with an overnight sleep study. For a diagnosis of sleep apnoea, more than five episodes per hour must occur.

MCQ exam: clinical scenario

A mother is concerned about her overweight 6 year old son who appears to be constantly tired during the day. She has noticed that her son has loud snoring and mouth breathing which causes the child to awaken frequently, often coughing and gasping for breath.

Appropriate management should include:

a) No medical treatment required
b) refer to an ENT specialist
c) Cromoglycate inhalers
d) inhaled low dose corticosteroids
e) Single dose 1 ml 0.5% salbutamol

MCQ exam: answer

The correct answer is B.
Affected children need to be referred to ENT team as soon as possible.

MCQ exam: explanation

It is essential to refer these children to an ENT specialist to assess for adenoid and tonsillar hypertrophy.

Obstructive sleep apnea occurs during deep levels of sleep, is associated with snoring and mouth breathing, and causes the child to awaken frequently, often coughing and gasping for breath. This cycle may recur continuously during the night, robbing the child of necessary REM sleep due to intermittent airway obstruction. Children with OSA are often drowsy during the day and they and their families suffer emotionally as well as physically.

The most important piece of information that will uncover an association between allergy and OSA is the child's weight, as up to 17% of obese children experience OSA. Additional questions to pursue include the presence of snoring and mouth breathing during the night, as well as frequent nocturnal crying, awakening, coughing, and gasping for breath.

Once the association is made, it is essential to refer these children to an ENT specialist to assess for adenoid and tonsillar hypertrophy, which may further cloud the diagnostic picture.