Pediatric sleep apnea:
signs, causes & treatment

Most people associate sleep apnea with overweight adults. But sleep apnea affects children too — and in kids, the most common cause is enlarged tonsils and adenoids, not body weight. Pediatric sleep apnea is underdiagnosed, in part because parents don't always recognize the signs, and in part because the daytime symptoms can easily be mistaken for behavioral or attention problems.

If your child snores regularly, seems to struggle to breathe during sleep, or wakes up tired despite a full night in bed, a pediatric ENT evaluation is an important step. At Seaside ENT in Brooklyn and Staten Island, Dr. Ruwaa Samarrai evaluates children for sleep-disordered breathing and helps families understand what is happening and what the treatment options are.

What is pediatric obstructive sleep apnea?

Obstructive sleep apnea (OSA) occurs when the upper airway partially or completely collapses during sleep, causing repeated interruptions in breathing. In children, these collapses are most commonly caused by enlarged tonsils and adenoids that physically narrow the airway when the muscles relax during sleep.

Each time the airway collapses, the brain briefly wakes the child to restore breathing — often without either the child or the parent realizing it is happening. These micro-arousals fragment sleep, preventing the deep, restorative rest that growing children need.

Nighttime signs to watch for

Daytime symptoms parents often miss

Because children with sleep apnea rarely complain of feeling tired, the daytime effects are frequently misattributed to behavioral or developmental issues. Symptoms to watch for during the day include:

What causes sleep apnea in children?

The most common cause by far is enlarged tonsils and adenoids. Children's tonsils and adenoids are naturally large relative to their airway size, and when further enlarged by repeated infections or chronic inflammation, they can significantly narrow the space available for breathing during sleep.

Other contributing factors include:

• Nasal congestion from allergies or enlarged adenoids blocking nasal breathing
• Obesity — an increasingly common contributing factor in older children
• Craniofacial anatomy — a small jaw or high arched palate can narrow the airway
• Low muscle tone — seen in conditions like Down syndrome

How is pediatric sleep apnea diagnosed?

Diagnosis begins with a thorough history and physical examination by a pediatric ENT. Dr. Samarrai will examine the tonsils, adenoids, nasal passages, and overall airway. She will ask detailed questions about your child's sleep patterns, nighttime symptoms, and daytime behavior.

In many cases, the clinical picture — large tonsils, classic nighttime symptoms, and daytime behavioral effects — is sufficient to guide treatment. A formal sleep study (polysomnography) may be recommended in certain cases, particularly when the diagnosis is uncertain or the child has additional medical complexity.

Treatment options

For most children with obstructive sleep apnea caused by enlarged tonsils and adenoids, the first-line treatment is adenotonsillectomy — surgical removal of the tonsils and adenoids. This is one of the most commonly performed procedures in pediatric ENT surgery, and it resolves or significantly improves sleep apnea in the majority of children.

For children where surgery is not indicated, or as an adjunct, other options may include:

• Nasal steroid sprays to reduce adenoid size and nasal inflammation
• Allergy management if allergic rhinitis is contributing
• Weight management support in older children where obesity is a factor
• CPAP therapy in selected cases where surgery is not appropriate

Frequently asked questions

Serving Brooklyn & Staten Island families

Seaside ENT sees patients at 6818 3rd Ave, Brooklyn, NY 11220 in Bay Ridge and 1191 Forest Ave, Staten Island, NY 10310. Dr. Samarrai speaks both Arabic and English. Most major insurance plans are accepted including Medicaid.