# Paediatric Obstructive Sleep Apnoea Referral - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012 · Pediatric Obstructive Sleep Apnea - StatPearls - NCBI Bookshelf - disease-level clinical article (paediatric-obstructive-sleep-apnoea-referral-full.txt) - Verified date: 2026-08 ## Verified against - AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012 - No dose - referral pathway, no medicine given in primary care - Pediatric Obstructive Sleep Apnea - StatPearls - NCBI Bookshelf - disease-level clinical article (paediatric-obstructive-sleep-apnoea-referral-full.txt) ## Treatment metadata - Mometasone furoate — 0.05 mg — nasal - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text PAEDIATRIC OBSTRUCTIVE SLEEP APNOEA REFERRAL Sources: AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012 · Pediatric Obstructive Sleep Apnea - StatPearls - NCBI Bookshelf - disease-level clinical article (paediatric-obstructive-sleep-apnoea-referral-full.txt) Review status: REVIEWED against AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012, No dose - referral pathway, no medicine given in primary care, Pediatric Obstructive Sleep Apnea - StatPearls - NCBI Bookshelf - disease-level clinical article (paediatric-obstructive-sleep-apnoea-referral-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Carers describe snoring, breathing through the mouth, and pauses in breathing they have watched happen [apnoea · mouth breathing · snoring] - Waking repeatedly at night, and bedwetting that has come back after a dry spell - Unlike adults, the standout feature in a child is altered behaviour - Broken sleep shows itself as overactivity, short temper or aggression, which is often what brings the family in - Odd sleeping postures and bedclothes thrown about suggest heavy movement overnight - Struggling academically is an accepted feature of sleep-disordered breathing at this age - Families often say nothing about sleep unless directly asked SIGNS - what you find (7) - The child looks either worn out or, the other way round, wound up [fatigue] - Dark rings under the eyes and a boggy, swollen nasal lining - Small lower jaw, large tongue and a high vaulted palate - Adenoid facies with enlarged tonsils - Speech sounds blocked, and the nose is obstructed - Check muscle tone neurologically, and examine the heart for pulmonary hypertension [hypertension] - Weigh and measure at every visit: each 1 kg/m2 of BMI beyond the 50th centile adds roughly 12% to the risk TESTS (11) - Guidance is to ask how much and how well the child sleeps, and whether they snore, at each routine check - Screen repeatedly in neuromuscular disease, Down syndrome and craniofacial malformation - As many as 9.4% of school-age children born preterm are later found to have the condition - Refer a preterm child for a sleep study readily, since the classic picture is often absent - Teen STOP-BANG runs to 8 yes-or-no items: 0-2 is low risk, 3-4 intermediate, 5-8 high - An overnight sleep study is the definitive test once history and examination raise the suspicion - An apnoea-hypopnoea index of 1 or more counts as abnormal up to age 13, although a value of 1 to 1.9 per hour is still argued over - Home oximetry overnight supports the picture but cannot confirm the diagnosis - Home sleep testing is accepted for straightforward adult disease, but the AASM judges the evidence too thin in children - Chest film and ECG where an underlying heart or lung disorder is suspected - Echocardiography matters particularly ahead of surgery in a child with severe disease IF NOT THIS - what else fits (6) - Allergic rhinitis blocking the nose - Attention deficit hyperactivity disorder - Developmental delay - Night-time gastro-oesophageal reflux - Parasomnias, commoner here but not specific - Narcolepsy in an older child who is sleepy by day Source StatPearls "Pediatric Obstructive Sleep Apnea" - disease-level clinical article Status traced to the source above 1. MOMETASONE FUROATE [1st line] Adult Not applicable - pediatric condition x 6-12 weeks trial Peds 2 years and over: 50 mcg (1 spray) into each nostril once daily in the morning for 6-12 weeks (Children >=2 years: 50 mcg (1 spray) into each nostril once daily in the morning for 6-12 weeks) Source AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012 Why Intranasal corticosteroid trial reduces adenoid tissue size and mild OSA severity in children pending ENT referral Caution SPECIALIST ENT REFERRAL MANDATORY: Definitive treatment for pediatric OSA with adenotonsillar hypertrophy is adenotonsillectomy. Intranasal steroids are suitable for mild OSA or while awaiting surgical evaluation. Direct spray away from nasal septum to avoid epistaxis. Egypt SNIFFACAN 50MCG/G NASAL SPRAY 15 ML SIGMA TEC 25.20 EGP TABUNEX 50MCG/G NASAL SPRAY 120 DOSES TABUK PHARMACEUTICAL MANUFACTURING... 28.80 EGP NORHINOSE 50MCG/DOSE NASAL SPRAY 120 DOSES EUROPEAN EGYPTIAN PHARM. IND.... 90.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source No dose - referral pathway, no medicine given in primary care Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - AHI greater than 9 events per hour (or mild-to-moderate disease with significant symptoms) is the threshold that warrants referral for adenotonsillectomy rather than continued medical trial. RED FLAG - Complex comorbidities (obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders) may require positive airway pressure therapy or, in severe cases, tracheotomy - a different pathway from a nasal-steroid trial. Oral or systemic steroids have no role in paediatric obstructive sleep apnoea; only the intranasal route has evidence of benefit. Montelukast carries a risk of serious neuropsychiatric adverse effects including suicidal ideation, depression, anxiety, agitation and hallucinations. Examine the cardiovascular system for signs of pulmonary hypertension, and assess muscle tone, in any child being worked up for obstructive sleep apnoea. The increased work of breathing can cause failure to thrive, particularly in younger children. Children born prematurely may not show the classic features, so refer for a sleep study at a low threshold. Assess sleep quality and duration in every child being evaluated for ADHD before any medication is started. Secondary nocturnal enuresis in a child is itself a reason to evaluate for obstructive sleep apnoea. Children with Down syndrome or craniofacial abnormalities need post-operative surveillance and a repeat sleep study at least yearly, because the apnoea often persists or recurs after surgery. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)