Comment

Comment by Steven Y. Park, MD on January 8, 2009 at 11:06pm

It's worse than you think. They've estimated that about 1/4 to 1/3 of all children on medications for ADHD actually have untreated obstructive sleep apnea. In many of these children, a simple adenotonsillectomy can be curative.

The bad news is that there are some children that don't respond to having their tonsils removed, and even the ones that improve don't improve completely. This only goes to show that ultimately, it's a jaw/structural problem.

Another Stanford study showed that children who underwent adenotonsillectomy and rapid palatal expansion got even greater benefits than tonsillectomy alone.

In Iceland, they routinely screen all school-aged children for sleep apnea.

Comment by E.M. on December 21, 2008 at 11:32pm

Very helpful. Thank you!

Comment by Mike on December 17, 2008 at 8:46pm

If you suspect that your child has obstructive sleep apnea (OSA), you may want to consult first with your child's primary care provider (usually a pediatrician or family physician) and share your concerns. You may also choose to consult with an otolaryngologist (ear, nose, and throat specialist or ENT) or a pulmonologist (a specialist in lung problems) who deals with children. Sometimes, because of the hyperactivity, inattentiveness, aggressive behavior, irritability, and mood swings associated with pediatric OSA, a mental health provider, such as a child psychiatrist or psychologist, or a neurologist may be the first to recognize the problem.

Doctors who specialize in sleep medicine may also practice in your area. They have usually trained under other sleep specialists and/or studied sleep medicine through a residency program, continuing medical education (CME) courses, and scientific meetings. Physicians certified by the American Board of Sleep Medicine have passed standardized tests on both pediatric and adult sleep disorders. You should ask any doctor or health care provider about his/her credentials and experience, especially in dealing with children. You should be satisfied with the explanations and how it will be diagnosed and treated in your child's particular case.

Based on the initial evaluation, your health care provider may suggest an overnight sleep study. A sleep study or polysomnogram can help to make a diagnosis of OSA in children and can help to judge the severity of the problem.

The recording devices used during a sleep study are similar in adults and children. These generally include an electroencephalogram (EEG) to measure brain waves and an electroculogram (EOG) to measure eye and chin movement, both to monitor the different stages of sleep; an electrocardiogram (EKG) to measure heart rate and rhythm; chest bands to measure breathing movements; and additional monitors to sense oxygen and carbon dioxide levels in the blood as well as monitors to record leg movement. None of the devices is painful and there are no needles involved, and sometimes the technician can attach the monitoring devices after the child has fallen asleep in the lab. Still the process may be a little frightening for a young child. Most sleep labs accommodate a parent's stay with the child overnight.

There are currently only a few clinics around the country that specialize specifically in pediatric sleep problems. However, many sleep study facilities (usually called sleep labs or sleep centers) perform studies on children as well as adults. Check first to make sure that the facility you use is equipped to handle children and that the sleep lab technicians are comfortable working with them. You should also ask if the doctor who will interpret the sleep study is familiar with reading pediatric sleep studies as they differ some from those of adults.

OSA in children is a serious disorder that, untreated, may result in health problems as well as behavior and academic problems. Although common, OSA often goes unrecognized, but it can usually be easily treated if detected. Symptoms of pediatric OSA should not be ignored. (American Sleep Apnea Association)