Obstructive apnoea in snoring infants

Author Prof. J. Spranger, University Department of Pediatrics Mainz

In a comprehensive Finnish sleep study, polysomnographic apnoea was detected in 9 out of 31 snoring infants [1]. To answer the question of whether there are clinical criteria for the identification of a particular risk of short-term respiratory failure, the 9 snoring children with apnoea were compared to the 22 children without apnoea.

The results show that the children in the apnoea group:

  • snored longer
  • had a greater tendency for mouth breathing and
  • had larger adenoids than snoring children without apnoea.

In conclusion, the results suggest that mouth breathing and large adenoids in long snoring infants justify a polysomnography to detect prolonged apnoea and even hypoxia. An interesting finding was that hyperplastic tonsils were not a notable factor contributing to the risk of apnoea in infants.

Comment: Snoring is harmless and often subsides with age. It disturbs the people around the child and not the affected infant. If their nose is blocked, infants breathe through the mouth. Factors such as hypotonia, obesity, and craniofacial anomalies change the situation. They contribute to the risk of respiratory airflow cessation, i.e. apnoea in the true sense of the word. Such occurrences can be predicted by a polysomnography, possibly even by a dynamic MRI [2]. Concerns about poor sleep quality and in certain cases also behavioural disorders in infants potentially justify the removal of hyperplastic adenoids.

[1] Markkanen S, Rautiainen M, Himanen SL. Snoring toddlers with and without obstructive sleep apnoea differed with regard to snoring time, adenoid size and mouth breathing. Acta Paediat 2021; 110(3):977–984.
[2] Fleck RJ, Shott SR, Mahmoud M, et al. Magnetic resonance imaging of obstructive sleep apnea in children. Pediat Radiol 2018; 48(9): 1223–1233.