Pediatric Snoring Treatment in Singapore

Primary snoring, also known as simple snoring, occurs without signs of sleep apnoea or significant airway obstruction. Children with primary snoring produce snoring sounds but may maintain normal oxygen levels and sleep patterns. This type typically doesn’t cause daytime symptoms or behavioural issues.

This intermediate condition involves increased breathing effort during sleep due to airway narrowing. Children may experience frequent brief arousals that can fragment their sleep, potentially leading to daytime tiredness despite not having full apnoea episodes. The breathing effort increases, but airflow continues.

This form involves complete or partial airway obstruction during sleep, leading to breathing interruptions. Children with sleep apnoea may experience drops in oxygen levels and frequent sleep disruptions. This type may require medical evaluation as it can potentially affect growth, cognitive development, and cardiovascular health.

*Individual symptoms and severity may vary.*

• Loud, persistent snoring occurring regularly
• Breathing pauses or gasping during sleep
• Restless sleep with frequent position changes
• Sleeping in unusual positions (neck hyperextended)
• Mouth breathing throughout the night
• Sweating excessively during sleep
• Bedwetting in previously toilet-trained children

• Excessive daytime sleepiness or fatigue
• Morning headaches
• Difficulty concentrating at school
• Behavioural problems or hyperactivity
• Poor academic performance
• Slow growth or failure to thrive
• Frequent throat infections

• Observed breathing cessations
• Cyanosis (bluish skin colour) during sleep
• Difficulty arousing the child from sleep
• Chest retractions (sucking in of the chest wall during breathing)
• Failure to gain weight appropriately

Children with paediatric snoring often show gradual symptoms, with parents initially dismissing mild snoring as usual. Symptoms may worsen during upper respiratory infections or allergy seasons.

Conservative treatment approaches form the first line of management for mild paediatric snoring without significant sleep apnoea.

Intranasal corticosteroid sprays reduce inflammation in the nasal passages and can shrink adenoid tissue. These medications, such as mometasone or fluticasone, may be used daily with regular monitoring. Treatment may be effective when allergies contribute to nasal obstruction.

Leukotriene receptor antagonists, such as montelukast, can reduce adenoid size and improve nasal airflow in children with allergic rhinitis. These medications work by blocking inflammatory pathways and are taken orally once daily. Some children may benefit from antihistamines for allergy control, though sedating varieties should be avoided, as they can worsen sleep-disordered breathing.

For overweight children, structured weight-loss programmes that include dietary modification and increased physical activity can help reduce snoring severity. Weight reduction may improve airway patency during sleep. Programmes may involve the whole family and include consultations with paediatric nutritionists to develop age-appropriate dietary plans.

Comprehensive allergy testing and immunotherapy can address underlying triggers of nasal congestion and snoring. Sublingual immunotherapy offers a needle-free option for children with specific allergen sensitivities, gradually desensitising them to triggers.

Surgical removal of enlarged tonsils and adenoids is a treatment option for paediatric obstructive sleep apnoea. This procedure may be effective in otherwise healthy children with adenotonsillar hypertrophy. Surgery is performed under general anaesthesia and typically requires one night of hospital observation. Modern techniques like coblation may reduce postoperative pain and bleeding risk compared to traditional methods.

For children with enlarged inferior turbinates causing nasal obstruction, radiofrequency turbinate reduction offers a minimally invasive option. This procedure shrinks swollen turbinate tissue, improving nasal airflow without removing important nasal structures. Recovery is typically quick and minimally uncomfortable.

In select cases where tongue base obstruction contributes to snoring, procedures like lingual tonsillectomy or tongue base suspension may be considered. These are typically reserved for children with persistent symptoms after adenotonsillectomy or those with specific anatomical variations.

Orthodontic devices that widen the upper jaw can increase nasal cavity volume and reduce airway resistance. This treatment may work well in children when facial bones are still developing. The expansion device may be worn with regular adjustments by an orthodontist.

Whilst not all cases of paediatric snoring are preventable, several strategies may help reduce risk and severity. Maintaining a healthy weight through balanced nutrition and regular physical activity may help prevent excess tissue accumulation around the airway. Creating an allergen-free sleep environment by using hypoallergenic bedding, regularly vacuuming with a HEPA filter, and controlling humidity can help reduce nasal congestion.

Establishing good sleep hygiene includes maintaining consistent bedtimes, allowing adequate sleep duration for age, and keeping electronic devices out of bedrooms. Avoiding exposure to secondhand smoke is essential, as it can increase airway inflammation and may raise the risk of sleep-disordered breathing. For children with allergies, consistent use of prescribed medications during allergy season may help prevent nasal congestion that can contribute to snoring. Early orthodontic evaluation can help identify and address jaw development issues.