Yes, enlarged or swollen tonsils can cause or significantly contribute to obstructive sleep apnea (OSA) in both children and adults. When tonsils become large, they can block or narrow the airway during sleep, leading to repeated episodes where breathing stops or is reduced. For some people—especially children—removal of the tonsils can improve or even resolve sleep apnea. This article will explain when tonsils cause sleep apnea and whether surgery is the right solution.

How Do Enlarged Tonsils Lead to Sleep Apnea?

Enlarged tonsils can cause sleep apnea by physically blocking or narrowing the airway during sleep. Here’s how this occurs:

• Airway Obstruction: The tonsils are located at the back and sides of the throat. When they become enlarged—due to infection, inflammation, or simply being naturally large—they can partially or completely block the airway. This is more likely to happen when a person is lying down and muscle tone decreases during sleep.
• Muscle Relaxation During Sleep: As we fall asleep, the muscles in the head and neck (which help keep the airway open) relax. If the airway is already narrowed by enlarged tonsils, this relaxation can cause the airway to collapse or close off entirely, leading to episodes where breathing temporarily stops (apnea) or is reduced (hypopnea).
• Interrupted Breathing: These blockages can last 10 seconds or longer and may occur repeatedly throughout the night. This leads to low oxygen levels in the blood and frequent awakenings, often without the person being fully aware.

Sleep apnea from enlarged tonsils can occur in both children and adults, but it is more common in children. While obesity is a more common cause of OSA in adults, massively enlarged tonsils can also cause airway obstruction and sleep apnea.

Symptoms of sleep apnea include restless sleep, loud snoring, mouth breathing, and frequent awakenings. Over time, this disrupted sleep can cause excessive daytime sleepiness, irritability, behavioral issues in children, and even long-term cardiovascular or lung problems if left untreated.

Should You Consider Tonsil Removal for Sleep Apnea?

Tonsil removal (tonsillectomy) can be an effective treatment for obstructive sleep apnea (OSA) in both children and adults, but whether you should consider it depends on several factors.

Children

Tonsillectomy (often combined with adenoidectomy) is the standard first-line treatment for pediatric sleep apnea when enlarged tonsils and/or adenoids are present. Surgery is highly effective in children, with success rates reported as high as 83%. Positive airway pressure therapy (like CPAP) is less commonly used in children due to concerns about facial growth and tolerance.

Adults

Tonsillectomy can be effective for adults with OSA, especially if they have markedly enlarged tonsils (tonsil grade 2-4). Studies show significant reductions in apnea-hypopnea index (AHI) and improvements in daytime sleepiness after tonsillectomy in adults with large tonsils. A 2016 review of 17 studies found that tonsillectomy decreased AHI by 65%.

For adults, positive airway pressure therapy (CPAP) is usually the first-line treatment. Surgery is considered mainly for those who cannot tolerate or do not benefit from CPAP, or when enlarged tonsils are clearly contributing to airway obstruction. Not all adults with sleep apnea are candidates for tonsillectomy, since it is mainly recommended for those with enlarged tonsils and documented sleep apnea in a sleep study.

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What Are the Risks and Recovery Considerations?

Tonsillectomy is generally safe, but carries surgical risks such as bleeding, infection, pain, dehydration, and anesthesia complications. A study of over 100,000 children showed that about 3% of children had revisits for bleeding complications after surgery. Another common complication from tonsillectomy is nausea and vomiting after the procedure. While this has been reported to occur in up to 70% of patients, medications can help manage these particular symptoms.

Recovery time is typically 1–2 weeks for children, but can be longer for adults. During this time, patients may need to adhere to restricted diet and activity. Adequate rest and hydration are important during the recovery period. Children can typically return to school within 7-10 days, and adults can usually return to work in about 10 days after a tonsillectomy.

In some cases, sleep apnea persists after removal if other factors are involved (e.g., obesity). Further evaluation and treatment may be necessary if symptoms persist after surgery.

When to Talk to a Doctor About Tonsil Removal

You should consider consulting a doctor or ENT specialist about tonsil removal (tonsillectomy) if you experience any of the following:

• Loud snoring
• Restless sleep
• Pauses in breathing during sleep
• Excessive daytime sleepiness
• Difficulty breathing at night
• Frequent sore throats or tonsil infections
• Difficulty swallowing
• Enlarged tonsils confirmed by a doctor

Conclusion

Enlarged tonsils are a significant and often treatable cause of obstructive sleep apnea in both children and adults. When they lead to airway blockage during sleep, it can result in disrupted breathing, poor sleep quality, and a range of health consequences if left untreated. Tonsillectomy is highly effective in resolving sleep apnea caused by enlarged tonsils in children and can also provide substantial benefit for selected adults, particularly those with markedly enlarged tonsils and mild to moderate OSA. While tonsil removal can bring relief, it’s important to consult with a sleep specialist or ENT to determine if it’s the right choice.

References

1. Bohr, C., et. al. Updated 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed on May 21, 2025 at https://www.ncbi.nlm.nih.gov/books/NBK536942/
2. Camacho, M., et. al. 2016. Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. In: The Laryngoscope. DOI: https://doi.org/10.1002/lary.25931
3. Epstein, L. J., et. al. 2009. Clinical Guideline for the Evaluation, Management, and Long-term Care of Obstructive Sleep Apnea in Adults. In: Journal of Clinical Sleep Medicine. Accessed on May 21, 2025 at https://aasm.org/resources/clinicalguidelines/osa_adults.pdf
4. Kang, K. T., et. al. 2024. Efficacy of adenotonsillectomy on pediatric obstructive sleep apnea and related outcomes: A narrative review of current evidence. Journal of the Formosan Medical Association = Taiwan yi zhi, 123(5), 540–550. https://doi.org/10.1016/j.jfma.2023.09.004
5. Mathew, P. G., et. al. 2023. Tonsillectomy for the Treatment of Suspected Sleep Apnea with Subsequent Improvement of Chronic Migraine. In: Practical Neurology. Accessed on May 21, 2025 at https://practicalneurology.com/diseases-diagnoses/headache-pain/tonsillectomy-for-the-treatment-of-suspected-sleep-apnea-with-subsequent-improvement-of-chronic-migraine/32005/
6. Reckley, L. K., et. al. 2018. The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews. Nature and science of sleep, 10, 105–110. https://doi.org/10.2147/NSS.S127816
7. Stanford Medicine. n.d. Risk Factors for Obstructive Sleep Apnea. Accessed on May 21, 2025 at https://stanfordhealthcare.org/medical-conditions/sleep/obstructive-sleep-apnea/causes.html
8. UMMC Health Care Ear, Nose, and Throat (ENT). Home Care after Tonsillectomy and Adenoidectomy - Adult. Accessed on May 21, 2025 at https://umc.edu/Healthcare/ENT/Patient-Handouts/Adult/Adenoids_tonsils/Tonsil_Adenoidectomy_Adult.html
9. UNC School of Medicine Otolarynology. Post-Operative Care Instructions Following Tonsillectomy. Accessed on May 21, 2025 at https://www.med.unc.edu/ent/services/pediatric-otolaryngology/post-operative-care-instructions-following-tonsillectomy/
10. University of Florida Health. 2023. Obstructive Sleep Apnea - Adults. Accessed on May 21, 2025 at https://ufhealth.org/conditions-and-treatments/obstructive-sleep-apnea-adults

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