Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Severe nocturnal hypoxaemia
Prolonged cyanosis, recurrent profound desaturation, respiratory failure, pulmonary hypertension or reduced consciousness requires urgent paediatric assessment rather than routine sleep referral.
Action: Assess airway, breathing and circulation, give oxygen when hypoxaemic while avoiding delay in ventilatory support, and involve paediatric respiratory, ENT and intensive care. Children with neuromuscular weakness, craniofacial obstruction or obesity hypoventilation may need urgent non-invasive ventilation planned by specialists; do not use sedatives or unmonitored home oxygen as a substitute for airway treatment.
Synopsis
Recognise paediatric obstructive sleep apnoea from nocturnal and daytime behaviour, identify high-risk syndromic and neuromuscular children, distinguish snoring from clinically significant obstruction, use polysomnography appropriately, and coordinate adenotonsillar, weight, nasal and positive-airway-pressure care.
Ask about habitual snoring, pauses, gasping, restless sleep, unusual positions, sweating, mouth breathing and enuresis. Children often show hyperactivity, irritability and poor concentration rather than obvious daytime sleepiness.
Examine nasal patency, tonsils, palate, jaw, neck, weight and blood pressure. Tonsil size while awake does not reliably grade sleep obstruction.
First-line assessment is a structured sleep history, video when available and risk examination. Primary snoring without gas exchange or functional effect remains a diagnosis of exclusion.
Key red flags
Witnessed prolonged apnoea, cyanosis, gasping or profound desaturation requires expedited paediatric sleep and airway assessment.
Investigation priorities
01
Reference standard: attended polysomnographyFirst stepReference standard
Measure obstructive events, sleep disruption, gas exchange and hypoventilation across sleep stages.
Management branches
AssessBuild a sleep phenotype
Habitual snoring, witnessed pauses or daytime impairment is reported.
Take structured night and day history and examine airway, growth, blood pressure and risk conditions.
Use video and oximetry for context without allowing a normal result to end high-risk assessment.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.