Obstructive Sleep Apnea (OSA)

  • If your child snores and has trouble breathing at night, it may not just mean that she’s a noisy sleeper. It could be a sign that she has obstructive sleep apnea (OSA), a common and treatable condition in which someone’s breathing is repeatedly blocked during sleep.

    Here are some basic facts about OSA:

    • Obstructive sleep apnea is caused by blockage of the upper airway in the back of your child’s nose or throat.
    • OSA is the most common type of sleep apnea. It affects about 2 to 5 percent of children, infants and teenagers.
    • OSA is sometimes caused by disorders that affect the structure of the jaw and face or the function of muscles.
    • The most common symptoms are snoring, gasping and noisy or difficult breathing during sleep.
    • OSA can also cause your child to be unusually tired, irritable or hyperactive during the day or to have poor school performance.
    • OSA is generally very treatable with airway pressure devices, surgery or other therapies.

    How Children’s Hospital Boston approaches obstructive sleep apnea:

    At Children’s, we treat children with obstructive sleep apnea through our Center for Pediatric Sleep Disorders, a team that includes pediatric specialists in NeurologyPulmonology and Developmental Medicine. Children whose sleep apnea is caused by enlargement of their adenoids and tonsils are also treated in the General Otolaryngology Program (ear, nose and throat specialists).

    Drawing on our extensive experience treating this disorder in young patients, we use a multidisciplinary approach to ensure the right treatment for your child's specific symptoms and circumstances.

    Our experts are leaders in developing strategies for helping children sleep well. Children's physicians see more than 3,000 children each year in our sleep clinics and laboratories and we treat children at locations in Boston, Lexington, Peabody, Waltham and Weymouth.

    Learn more about OSA from one of our doctors
    Dennis Rosen, MD, associate medical director for Pulmonology in Children’s Center for Pediatric Sleep Disorders, created this list of frequently asked questions about obstructive sleep apnea in children (PDF)

    Obstructive Sleep Apnea (OSA): Reviewed by Eliot Katz, MD
    © Children’s Hospital Boston, 2011

  • When obstructive sleep apnea (OSA) prevents your child from sleeping and breathing normally at night, it can be understandably alarming for parents.

    At Children’s Hospital Boston, we know how important it is for families to be fully informed about your child’s condition and treatment, and how OSA could affect her long-term health. We’ve provided answers to many commonly asked questions about OSA in the following pages, and when you meet with our team of doctors, we’ll be able to explain your child’s condition and treatment options fully.

    What is OSA?

    OSA is a type of sleep apnea. “Sleep apnea” is a common disorder in which one or more pauses in breathing occur during sleep. “Obstructive” means that these pauses happen because the upper airway is blocked. 

    Although a child with OSA tries to breathe during these episodes of blockage, she doesn’t get enough air.  Thus, sleep is disrupted and a decrease in the oxygen content of the blood may occur.

    What are the different types of sleep apnea?

    A rare type of sleep apnea is called central sleep apnea:

    • Central sleep apnea occurs when the area of the brain that controls breathing fails to send a signal to the muscles that control breathing.  Without this signal, the body doesn’t try to breathe for brief periods of time.
    • Central sleep apnea can occur in conjunction with OSA or by itself.
    • Central sleep apnea can affect anyone, but it typically occurs in people with certain neurological conditions. It’s also more common in adults and rarely affects children.
    • Apnea of prematurity (AOP) is a common type of central sleep apnea found in premature babies. AOP prevents a baby from taking continuous, controlled breaths.  In most cases, this type of apnea is diagnosed before the newborn leaves the hospital goes away on it’s own.

    How does OSA occur?

    • The soft tissues in the upper airway (the mouth, nose, throat and windpipe) get sucked inward every time we inhale, resulting in airway obstruction.
    • OSA usually occurs during sleep, the time when the soft tissue is most relaxed.  During sleep, a child’s muscle tone decreases, allowing those tissues to fall closer together than they do when she’s awake.
    • This crowding in your child’s airway means that air has less room to get through. It can also make her upper airway temporarily collapse. This is similar to what happens when you suck on a drinking straw with your finger partially covering the end:  At some point, the straw collapses, so you can’t suck any air through it.
    • When the lungs don’t get enough air, it can change the levels of oxygen and carbon dioxide in the blood. Your child’s body may fix the problem by partially waking up, causing interruptions in her sleep.

    Is OSA harmful?

     It can be. OSA means that your child isn’t sleeping and breathing well at night, so during the day, she may be unusually tired, irritable or hyperactive.

    If left untreated, OSA can also have more long-term consequences, including:

    • cognitive problems (learning disabilities, hyperactivity and mood disorders)
    • high blood pressure
    • metabolic problems or hormone imbalances



    OSA is caused by the obstruction of the upper airway in the back of your child’s throat.

    The most common types of blockage involve:

    • enlargement of the tonsils and adenoids (the spongy, glandular tissues at the back of the throat). This is the most common cause of OSA in children.
    • fat that deposits in your child’s upper airway due to obesity

    OSA can also be caused by a variety of disorders that affect the structure of the jaw and face or the function of muscles, such as:

    • Nasal allergies and craniofacial conditions can also cause obstructions that lead to OSA in children.


    Signs and symptoms

    What are the symptoms of OSA?

    A child with OSA may:

    • snore loudly or have noisy breathing during sleep
    • experience periods when she has a hard time breathing, which typically last six to 20 seconds and often end in a gasp, snore, snort or sigh
    • sleep with her mouth open or neck extended
    • have restlessness during sleep
    • excessive sleepiness, irritability or hyperactivity during the day or poor school performance
    • wake up with a dry mouth or headaches in the morning
    • experience occasional bedwetting

    If you suspect your child might have OSA, talk to her primary care doctor about her symptoms. Your doctor may refer you to Children’s for a full evaluation, which often includes a sleep study.

    Questions to ask your doctor

    You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.

    If you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

    If your child is old enough, you may want to suggest that she write down what she wants to ask her doctor, too.

    Some of the questions you may want to ask include:

    • Is my child’s snoring a sign of a serious problem?
    • What seems to be causing the problem?
    • Are there any additional symptoms I should be on the lookout for?
    • How can my child’s condition be treated?
    • How could this affect my child’s long-term health?
    • What do we do next?
    • If a sleep study is recommended, what will happen during the sleep study? What should we do to get ready?
    A tour of the sleep laboratory
    What exactly happens during a sleep study? Take a virtual tour of the sleep lab Franco describes his experience as a patient in the Center for Pediatric Sleep Disorders
  • Forming a complete and accurate diagnosis is the first step in treating your child’s obstructive sleep apnea (OSA). At Children’s Hospital Boston, we have expertise in evaluating children’s symptoms and providing treatment that is specifically tailored to each child’s individual condition.

    How do I know if my child has OSA?

    The symptoms of OSA can often be more difficult to detect in children than in adults, since an adult probably knows she’s feeling especially tired due to not having a good night’s rest. A child, on the other hand, may not look sleepy, even if she’s not sleeping well. She may be moody or inattentive or have problems in school—or she may not have any obvious problems.

    If you think your child might have a sleep disorder such as OSA, talk to her primary care doctor about her your concerns. If your doctor suspects a diagnosis of OSA, your child’s pediatrician may refer your child to Children’s for a consultation with our sleep specialists or to one of our otolaryngologists (ear, nose and throat doctors).

    How is a diagnosis of OSA made?

    Physicians in our Center for Pediatric Sleep Disorders use a number of different tests to help us accurately diagnose your child’s disorder and evaluate her condition.

    To learn about your child’s situation, one of our specialists may:

    • take a detailed medical history and perform a physical examination
    • talk with your family to find out about how your child breathes while asleep
    • talk with your family about whether your child’s sleep problems are having any negative effects on her—such as behavior or school problems
    • evaluate your child’s upper airway (by direct examination or x-ray)


    Tests used to confirm a suspected diagnosis may include:

    • Multiple Sleep Latency Test (MSLT), a daytime nap study that helps make specific sleep-disorder diagnoses by measuring how quickly your child can fall asleep and identifying the type of sleep attained
    • Maintenance of Wakefulness Test (MWT), a test that measures sleepiness by recording a child's brain and body activity at certain times throughout the day
    • actigraphy, a noninvasive test that uses a sensor that measures a child's body movements
    • overnight oximetry, a test in which a plastic clip is placed on a child's finger to track heart rate and blood oxygen content during sleep
    • polysomnogram, a sleep study used to assess quality of sleep and detect any sleep disorders


    What happens during a sleep study?

    During a sleep study, you and your child spend a night in our sleep laboratory so we can carefully observe how your child sleeps. We use a test called a polysomnogram to record things such as brain waves, eye movements and heart rate. This is the best way to know whether your child has obstructive sleep apnea, and if so, how severe it is.

    Sometimes, it’s helpful for you to take a short video of your child sleeping, when her breathing is at its worst. If you’ve done that, be sure to bring the video to your appointment. Keeping a sleep diary is also a good idea. Keep track of how many hours of sleep your child had, how many times she woke up during the night and how alert she feels in the morning.

    These strategies may help your doctor diagnose your child’s condition and speed up the process of starting treatment.

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then we will talk with you and your family to outline the best treatment options.

    Specialized equipment and techniques

    Children’s sleep clinics and laboratories use advanced methods and sleep-monitoring technologies to study your child’s sleep and breathing patterns. These allow us to noninvasively diagnose even subtle forms of sleep disorders and help lead us to the best treatments for your child. Our sleep studies page explains sleep studies in more detail. And in our sleep study walkthrough, you and your child can actually see what a sleep study is all about.

  • At Boston Children's Hospital, we take obstructive sleep apnea seriously: We know that it can have real effects on your child's health, behavior and quality of life. Our specialists in the Center for Pediatric Sleep Disorders have extensive experience in treating all forms of the condition and are here to help. 

    Can OSA be treated?

    Yes, the therapies available for children experiencing OSA are very effective. With the proper treatment, children will usually be able to get relief from their symptoms and sleep and breathe well at night.

    Why is treatment important?

    Although your child may outgrow her OSA as the structures in her throat change, not sleeping well now can have long-term consequences that affect her growth and development, including:

    • cognitive problems (learning disabilities, hyperactivity and mood disorders)
    • high blood pressure (and possibly more serious cardiovascular problems in adulthood)
    • metabolic problems or hormone imbalances (such as glucose intolerance or changes in the amount of growth hormone)

    Getting care for your child's nighttime breathing problems can have far-reaching positive effects on her ability to function well during the day and on her overall health.

    What treatments are available?

    Strategies to help children get back to breathing well at night often include:

    •  tonsillectomy and adenoidectomy, where your child's tonsils and adenoids (soft tissues located above the roof of the mouth) are surgically removed at the same time.
    • weight loss for children who are overweight
    • surgery to remove the excess tissue from the nose and throat if OSA is caused by abnormalities in facial structure
    • continuous positive airway pressure (CPAP), a device used to maintain the airway during sleep 

    How does a CPAP machine work?

    A CPAP machine increases air pressure in the throat, so a child's airway does not collapse when breathing while he's asleep.

    The air stream is delivered through one of the following:

    • a mask that covers the nose, only
    • a mask that covers the nose and mouth
    • small prongs that fit into the nostrils

    What side effects may occur from using a CPAP machine?

    Although most children experience none, some of the following side effects may occur:

    • dry nose, nosebleeds
    • nasal congestion, runny nose
    • sore throat
    • irritation of the eyes or face
    • headaches

    What makes Children's approach unique?

    The Center for Pediatric Sleep Disorders at Children's brings together doctors, nurses and sleep lab technologists who specialize in working with children with sleep disorders. We use advanced methods and sleep-monitoring technologies to study your child's sleep and breathing patterns, which allows us to non-invasively diagnose even subtle forms of sleep disorders and leads us to best treatment options. In addition, we perform modified sleep studies to observe and evaluate  any events that occur over the course of the night.

    Every aspect of what we do is designed specifically for children. We take time to carefully diagnose your child's condition and provide close follow-up care. At every step, we work together with your family, as we consider you to be a central part of our care team.

    Coping and Support

    This list outlines some of our resources at Children's and in the community that may be helpful to you:

    • Struggling to help your child get good sleep? You can find information and resources from our team on Children's sleep page.
    • The book Solve Your Child's Sleep Problems by Richard Ferber, MD, founder and former director of Children's Center for Pediatric Sleep Disorders, helps parents understand children's sleep and shows them how they can cure most of the problems themselves. First published in 1986, the book has since been revised and expanded in a new edition.
    • Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the Center's services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.
    • You may also want to visit the Children's For Patients and Families website, which has information on the wide array of support services available to families at Children's.

    Other resources

    Please note that neither Children's nor the Center for Pediatric Sleep Disorders unreservedly endorses all of the information found at the sites listed below.

    • The National Sleep Foundation is a nonprofit organization that promotes public understanding of sleep and sleep disorders and supports sleep-related education, research and advocacy to improve public health and safety.
    • The Healthy Sleep website, a resource developed by the Division of Sleep Medicine at Harvard Medical School with the WGBH Educational Foundation, provides information on the importance and science of sleep and resources for improving sleep quality.
    • The American Sleep Apnea Association is a nonprofit organization dedicated to reducing injury, disability and death from sleep apnea and to enhancing the well being of those affected by this common disorder.
    • The Restless Legs Syndrome Foundation is a nonprofit organization that provides information about RLS. Its goals are to increase awareness, improve treatments and, through research, find a cure for RLS.
    • Narcolepsy Network is a patient support organization providing education and information about this neurological sleep disorder.


    Sleep deprivation in teens: risky business?
    A recent study from the Centers for Disease Control shows that more than 60 percent of American teens aren't getting an adequate amount of sleep, which may make them more likely to engage in risky behaviors. Learn ways to help your child avoid sleep deprivation in this blog post published on Thriving, Children's pediatric health blog.
  • At Children’s Hospital Boston, our care is informed by our research, and our discoveries in the laboratory strengthen the care we provide at each child's bedside. In fact, Children’s scientific research program is one of the largest and most active of any pediatric hospital in the world.

    Our Center for Pediatric Sleep Disorders has long been a leader in developing techniques—especially our sleep studies—for diagnosing breathing problems that children can have during sleep. Our physicians are leading a number of studies to:

    • learn more about what can cause obstructive sleep apnea
    • understand how it affects children
    • develop protocols for diagnosing sleep apnea quickly and accurately
    • find new, more effective ways to treat it

    Among our research projects are:

    Experimental treatment

    It’s possible that your child will be eligible to participate in one of our clinical trials. These studies are useful for a multitude of reasons: Some trials are designed to evaluate the effectiveness of a particular treatment; others help doctors to better understand how and why certain conditions occur.

    Participation in any clinical trial is completely voluntary: We will take care to fully explain all elements of the treatment plan before the trial starts, and you may remove your child from the study at any time.

    Read more about our research on treatments for children with obstructive sleep apnea.

    Children speak: What it's like to be medical research subject

    In this video, the real experts on clinical research studies—the children participating in them—tell about their experiences.

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