SNORING & OBSTRUCTIVE SLEEP APNOEA
Snoring occurs when something (such as enlarged tonsils or adenoids) obstructs airfl ow through the airways during sleep.
Many obese children snore, as neck fat “strangulates” the airway.
Up to 5% of Singaporean children have Obstructive Sleep Apnoea (OSA), where the obstruction is so severe that air to
the lungs is greatly reduced. Th e heart and lung muscles work much harder for oxygen, and the lung muscles become so
tired that they stop inhaling and breathing. A non-breathing period of more than 10 seconds is an “apnoea”.
OSA may cause heart/lung strain, poor brainoxygenation and troubled sleep (night sweats, bed-wetting, waking frequently,
tossing and turning, gasping and sleeping in odd positions (eg sitting up or lying on his face, bottom in the air). In
the daytime, the child may be tired, irritable, less attentive, hyperactive (ADHD) and performing poorly academically.
Growth may be aff ected, because special growth hormones are produced during good sleep.
Chronic snoring or OSA in children may stretch upper airway tissues, leading to adult OSA and sometimes to abnormal
development of jaw, teeth and cheekbones (‘long (adenoidal) face’ syndrome). Approximately 60% of a child’s face is “built”
by the time he is four. Left unchecked, abnormal facial development may be irreversible.
If concerned, consult an ENT surgeon, preferably withan audio-visual recording of the child’s sleep.
MIDDLE EAR INFECTIONS Th e middle ear (behind the eardrum) can become infected. Th is area is drained and regulated
by the Eustachian Tube (ET) connected to the back of the nose. Children’s ETs are very short, so infection can easily
spread from nose to middle ear. Children’s ETs are immature and more horizontal (becoming more vertical as the child
grows and the face lengthens) and might not drain the middle-ear fl uid properly. Acute middle ear infection occurs when
the middle-ear fl uid becomes infected and develops mucopus, which (unless drained) builds up, stretching and bulging
the middle ear and sometimes, even rupturing the eardrum.
When middle ear fl uid is not properly drained, the eardrum cannot vibrate properly. Th is is called glue ear and can
cause hearing loss.
See if the child seems inattentive, can’t hear, speaks loudly, turns up the volume on the TV or has ear pain. Infants
and toddlers may cry for no apparent reason, holding or pulling their ear, especially at night.