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Obstructive sleep apnoea — MRCPCH FOP MCQ

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ModerateRespiratoryObstructive sleep apnoeaMRCPCH FOP

A 4-year-old boy has loud snoring, witnessed pauses in breathing and daytime behavioural difficulty. Examination shows large tonsils and his growth is tracking the 25th centile. What is the most appropriate management?

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Correct answer: A — Refer to ENT for assessment of adenotonsillar obstruction

Witnessed apnoeas with snoring and enlarged tonsils suggest obstructive sleep apnoea due to adenotonsillar hypertrophy, so ENT assessment is appropriate. Salbutamol would not address upper-airway obstruction. Reassurance alone is unsafe when there are apnoeas and daytime consequences. The pearl is that behavioural problems can be a presenting feature of sleep-disordered breathing in children.

Reference: NICE CKS Obstructive sleep apnoea syndrome; ENT UK guidance