Clinical Case Database / Category: Clinical Care

Tonsils and adenoids: sleep-related breathing disorders in children

Publication details

M Buckingham, AC Leong, DA Bowdler
Foundation Years Journal, volume 4, issue 7, p.5 (123Doc Education, London, July 2010)


Sleep-related breathing disorders (SBD) in children are common, ranging from snoring, which is a relatively benign and common condition, to obstructive sleep apnoea (OSA) at the other end of the spectrum, typically characterised by oxygen desaturation, reduced oronasal air flow and paradoxical movement of the chest and abdomen (see Figure 1) (1). In the UK, 12% of 4-5 year old children snore on a regular basis and the typical affected child who suffers from SBD is aged 2-5 years old (2). Up to 3% of children experience episodes of intermittent complete upper airway obstruction or OSA, which is the most extreme form of SBD (3). The purpose of this article is to highlight SBD in children to FY2 trainees as a common but serious condition which presents to general practitioners (GP), paediatricians and otolaryngologists, with a view to guiding trainees through its diagnosis and management.

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M Buckingham

ENT FY2 doctor at University Hospital Lewisham
Dept of Otolaryngology

AC Leong

ENT SpR at University Hospital Lewisham Dept of Otolaryngology

DA Bowdler

Consultant ENT Surgeon Dept of Otolaryngology
University Hospital Lewisham


1. Kotagal S. Childhood obstructive sleep apnoea. BMJ 2005;330: 978–979.
2. JM Graham, GK Scadding, P Bull. Pediatric ENT; Springer editions 2007 Chapter 14.
3. Robb PJ, Bew S, Kubba H et al. Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party. Ann R Coll Surg Engl 2009; 91: 371–373.
4. Section on Pediatric Pulmonology and Subcommittee on OSA Syndrome. Clinical Practice Guidelines Diagnosis and Management of Childhood OSA Syndrome. Paediatrics 2002; 109:704–712.
5. Owens J. Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatric Pulmonology 2009; 44:417–422.
6. Marcus CL, Katz ES, Lutz J et al. Upper airway dynamic responses in children with the obstructive sleep apnea syndrome. Pediatr Res 2005; 57:99–107.
7. Leong AC, Davis JP. Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach. The Journal of Laryngology & Otology 2007; 121:809–817.
8. Erler T, Paditz E. Obstructive sleep apnea syndrome in children: a state-ofthe-art review. Treat Respir Med 2004; 3:107–122.
9. Suen JS, Arnold JE, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995; 121:525–530.
10. Brouillette RT, Manoukian JJ, Ducharme FM et al. Efficacy of fluticasone nasal spray foe pediatric obstructive sleep apnea. J Pediatrics 2001; 138: 838-834.
11. Messner AH. Evaluation of obstructive sleep apnea by polysomnography prior to pediatric adenotonsillectomy. Arch Otolaryngol Head Neck Surg 1999; 125:353–356.
12. Wilson K, Lakheeram I, Morielli A et al. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology 2002; 96:313–322.
13. McColley SA, April MM, Carroll JL et al. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992; 118:940–943.
14. Faramarzi A, Shamseddin A, Ghaderi A. IgM, IgG Serum Levels and Lymphocytes Count before and after Adenotonsillectomy. Iran J Immunol. 2006; 3:187-191.
15. Kaygusuz I, Alpay HC, Gödekmerdan A et al. Evaluation of long-term impacts of tonsillectomy on immune functions of children: a follow-up study. Int J Pediatr Otorhinolaryngol. 2009; 73:445–449.


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