Etiology of OSA in Children Risk factors for obstructive sleep apnea in children include the following: Obesity (the most common cause) Enlarged tonsils or adenoids Allergic rhinitis (ie, causing significant nasal congestion) Craniofacial abnormalities (eg, micrognathia, retrognathia, midfacial hypoplasia, excessively angled skull base) Certain drugs (eg, sedatives, opioids) Mucopolysaccharidoses Disorders causing hypotonia or hypertonia (eg, Down syndrome, cerebral palsy, muscular dystrophies) Possibly genetic factors (eg, congenital central hypoventilation disorders that can include obstructive and central sleep apneas, and Prader-Willi syndrome and others) Symptoms and Signs of OSA in Children In most children with OSA, parents note snoring; however, snoring may not be reported even when OSA is severe.