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Guidelines for the Assessment of Sleep-Disordered Breathing in Children


About one third of children snore; about 10% snore most nights. As a symptom, snoring is often not considered unusual or to have health consequences. The impact is underappreciated by parents and families and often not mentioned or raised as a health issue with General Practitioners.

The way children present is often different than adults. An awareness of the potential significance of poor quality sleep in children is very important. Even in mild cases of Obstructive Sleep Apnoea (OSA) and in young children, untreated OSA may result in significant adverse consequences including impacts on cardiovascular health (e.g. hypertension) and poor sleep quality, leading to impaired daytime functioning affecting development, behaviour and learning.

Symptoms of sleep disordered breathing should be sought in any child with enlarged tonsils and/or disturbed or unrefreshing sleep, particularly if they have underlying comorbidities such as Down syndrome, obesity, previous cleft, craniofacial abnormalities or neuromuscular weakness, as the prevalence of underlying OSA and its subsequent consequences may be greater. OSA can often be diagnosed without the need for elaborate tests and treated effectively with adenotonsillectomy. However where the diagnosis is in doubt, there are underlying comorbidities, anaesthetic risk or ENT intervention fails to resolve symptoms, formal evaluation using sleep studies and consideration to other treatments (e.g. respiratory support) may be required.

The New Zealand Guidelines for the Assessment of Sleep-Disordered Breathing in Childhood 2014 was produced by the National Paediatric Sleep Medicine Clinical Network as an evidence-based summary for the assessment of children with sleep disordered breathing. It aims to address the following clinical management issues for paediatric health care professionals in New Zealand:

  1. How should general practitioners and paediatricians approach the investigation of a child who snores?
  2. Which children should be referred from around New Zealand to a sleep disorders centre for further evaluation?
  3. What treatments are available for disorders of breathing during sleep in childhood and what are the known benefits of these treatments?

Please click on the image below to download or view a pdf of the Guideline.

Sleep Medicine Guideline

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