Pediatric Obstructive Sleep Apnea...Could your child have it?

Is your child having difficulties concentrating in class? Is the teacher complaining that he or she is sleeping during class; or just the opposite, disrupting the class? The problem may be that your child has a condition known as Pediatric Obstructive Sleep Apnea (POSA). Known to afflict up to 4% of the population in kids, much attention has been paid to adult sleep disorders, but there has been relatively little discussion about this sleep disorder that affects children.

The hallmark sign of this disorder is snoring! That does not mean that if your child snores at night that he or she has POSA because up to 10% of children snore, but only 4% have POSA. It is also characterized by the presence of disruptive sleep throughout the night. A definitive diagnosis is made using Polysomnography to arrive at an Apnea Hypopnea Index (AHI) score. Any score greater than 1 episode during the night is indicative of POSA.

Risk factors associated with POSA include craniofacial abnormalities such as a severely retruded lower jaw or a severely constricted upper jaw, enlarged tonsils andadenoids, obesity, and Down’s syndrome.

The clinical symptoms of children associated with pediatric constructive sleep apnea include: disruptive, not nocturnal sleep, abnormal amount of movement during sleep, daytime fatigue, school difficulties, hyperactivity and or inattention, snoring, bedwetting, nocturnal sweating, daytime sleepiness, morning headache, sleepwalking.

If you suspect that your child suffers from POSA, an evaluation by your pediatrician or ear, nose and throat doctor should be scheduled immediately.

 The most effective treatments for POSA include tonsillectomy and/or adenoidectomy by an ENT, expansion of the palate by an orthodontist, and a combination of diet and exercise. Figure 1 below shows a palatal expansion appliance used to widen the palate and Figure 2 shows the effect of this appliance on the nasal cavity.

Figure 1

Figure 2

CPAP machines (shown on the child at left) have not been shown to be effective from a compliance standpoint and they do not address the cause of the problem. Morbidities associated with a POSA include: failure to thrive, developmental delay, difficulty concentrating, behavioral problems, hypertension, cor pulmonale, gastroesophageal reflux, therefore it is incumbent upon you to have your child evaluated immediately if you feel like he or she exhibits one or more of the symptoms discussed above.

If you have any questions regarding Pediatric Obstructive Sleep Apnea that you would like to address to me, please feel free to email me at admin@frigoortho.com. I hope that this blog entry has shed some light on this problem. Look for my next blog entry to discuss the problem of missing incisors and, as always, I welcome any feedback that you may have!