Which clinical history findings are characteristic of childhood obstructive sleep apnea (OSA)?

Updated: Feb 13, 2019
  • Author: Mary E Cataletto, MD; Chief Editor: Denise Serebrisky, MD  more...
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Not only do manifestations of obstructive sleep apnea (OSA) differ between children and adults, they also frequently vary from one child to another. Not every child with obstructive sleep apnea has the exact same constellation of symptoms. Keeping this in mind, perform a careful interview to explore the following issues when obstructive sleep apnea is suspected.

Although no specific prevention has been reported, a high index of suspicion in patients with predisposing conditions or suggestive history is necessary for early detection. The need for increased awareness of and screening for obstructive sleep apnea among primary care providers is significant. History obtained during preventive health visits should include questions regarding snoring (frequency, quality), obvious nocturnal airway obstruction or apnea, restless sleep, mouth breathing, daytime inattention, hyperactivity or hypersomnolence, and family history of obstructive sleep apnea. Loud snoring 3 or more nights per week warrants further investigation.

The clinical presentation of a child with obstructive sleep apnea (OSA) syndrome is nonspecific and requires increased awareness by the primary care physician. Indeed, the medical history is usually normal, unless the pathophysiology of sleep-associated airway obstruction is related to one of the various conditions delineated in Etiology.

Clinical findings of tonsillar enlargement or obesity should prompt questioning regarding snoring. Family history of snoring, allergies, and exposure to environmental tobacco smoke are all strongly related to snoring. In the otherwise healthy child, parents principally report snoring during sleep. History of loud snoring 3 or more nights per week should increase suspicion of obstructive sleep apnea.

Parents occasionally comment on breathing difficulties during sleep (eg, gasps or heroic snorts), unusual sleeping positions, morning headaches, daytime fatigue, irritability, poor growth and weight gain, and behavioral problems. Nevertheless, even in cases in which a sleep specialist conducts the diagnostic interview, the accuracy of obstructive sleep apnea prediction is poor and does not exceed a sensitivity and specificity of 50-60%, particularly in distinguishing obstructive sleep apnea from benign snoring.

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