Common presentation: snoring
We are concerned about snoring in children when it indicates that the child has obstructive sleep apnoea (OSA), i.e. snoring in association with periods of ineffective breathing lasting longer than 2 breaths (e.g. breath-ing at a rate of 20/min, this would be 6s). This is as opposed to central apneas, which are a pause >20s in an otherwise well child. The most com-mon cause of OSA is adenotonsillar hypertrophy. The other causes are as follows.
·Midface: e.g. hypoplasia in achondroplasia.
·Tongue: e.g. macroglossia in Beckwith syndrome, trisomy 21.
·Lower jaw: e.g. retro- and micrognathia.
·Syndromes: e.g. Pierre–Robin sequence, Treacher–Collins, Goldenhar, Apert.
· Gastro-oesophageal reflux.
When snoring is associated with OSA, the underlying cause needs to be treated.