Approach to a snoring child in primary care setting

Abstract

Snoring is a common presenting symptom of Obstructive Sleep Apnoeas syndrome (OSAS) in children. In Hong Kong, about 10% of children has habitual snoring (> 3x per week), while 5.8% of boys and 3.8% of girls aged between 5 and 13 years were found to have OSAS. (Li 2010). Hypertrophy of tonsils and or adenoids is the commonest cause of OSAS in children. Other contributing factors leading to airway obstruction include nasal obstruction, craniofacial abnormality, obesity and neuromuscular conditions. Assessment of the contributing factors and severity of symptoms in a child presenting with snoring by primary care doctors is essential, so to identify patients at risk of OSAS who need further evaluation by paediatric sleep specialists. Polysomnography (PSG) is considered gold standard for diagnosis of OSAS. However, PSG is an expensive and time-consuming procedure with long waiting time in public services. Overnight oximetry has a role in screening for the most severe cases that need early referral to ENT surgeon for surgical intervention. Meanwhile, use of anti-inflammatory agents for control of allergic rhinitis, education on weight control in obese children and promotion of sleep hygiene are interventions that can be initiated in primary care setting.