The presentation of obstructive sleep apnea in children differs from adult OSA in several key respects. Unlike adults, children with sleep disordered breathing may demonstrate hyperactivity and behavioral problems, symptoms which are sometimes mistaken for Attention Deficit Hyperactivity Disorder (ADHD). According to the American Sleep Apnea Association, as many as 25% of children diagnosed with ADHD may in fact have Obstructive Sleep Apnea, with their behavior being a consequence of chronically fragmented sleep.
SCREENING AND DIAGNOSIS Parents who notice any of the signs or symptoms listed here are encouraged to seek a consultation with their child's primary care provider. A referral to a certified sleep physician is typically the next step, as definitive diagnosis can only be made on the basis of a sleep test. Other providers who may be involved in the evaluation and treatment process include ENT specialists and orthodontists. In addition to health history, physical examination and sleep testing, new imaging technology such as Cone Beam Computed Tomography (CBCT) may be used to obtain valuable information about the size of the airway and the nature or location of the obstructions. This information is essential in determining the best course of treatment. |  SIGNS AND SYMPTOMS OF PEDIATRIC OSA: · noisy, irregular breathing or snoring during sleep; this may occur without apnea or deep oxygen desaturations, but still be characterized by significant respiratory effort and frequent arousals due to this effort. 3.2 to 12.1 % of children habitually snore, while the prevalence of OSA in children ranges from 0.7% to 10.3% |
HEALTH CONSEQUENCES
Children with sleep disordered breathing have an increased likelihood of learning problems and an almost 3-fold increased risk of neurobehavioral problems. Impaired growth, increased blood pressure (even in primary snoring) and cardiac abnormalities have also been associated with pediatric sleep disordered breathing, therefore it is important that all children who snore or exhibit some of the other signs listed above be screened and/ or tested for SDB. There is also a high prevalence of malocclusion in children with OSA and adenotonsillar hypertrophy (open bite, cross bite) as a result of chronic mouth breathing, so an orthodontic evaluation should be considered once a diagnosis of OSA is made, in order to determine the need and optimal timing for orthodontic correction.
TREATMENT OPTIONS
Since enlarged lymphatic tissues (relative to the size of the airway) is the most common cause of the obstruction, adenotonsillectomy is the typical first-line treatment, and may be curative in itself. Additional treatments may include orthodontic rapid palatal expansion to widen a constricted palate, make room for the tongue and teeth and enlarge the nasal airway, or surgical corrections of craniofacial abnormalities.
Other adjunctive treatments that may be considered in some cases include the medical management of nasal allergies, encouraging side sleeping with the use of positional devices or pillows, and a weight control program.
VIDEOS
Dr. Duane Grummons: Airway Focused Orthodontics
To see presentation click this link: https://vimeo.com/channels/1129113
Orthodontic pioneer, Duane Grummons, challenges us to look at orthodontics in a different way. This discussion highlights how we have failed to put into practice information that has been available to us for decades. Maybe it's time for us to catch up.
click HERE or download PDF
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http://www.researchgate.net/profile/Dorit_Koren2/publication/268336495_Metabolic_and_Glycemic_Sequelae_of_Sleep_Disturbances_in_Children_and_Adults/links/54bd2d3c0cf27c8f2814b077.pdf
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120655/
http://pediatrics.aappublications.org/content/early/2012/02/29/peds.2011-1402
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https://www.aacp.com/pdf%2F0811%2F0811ACP_Youssef.pdf
ADHD or Sleep Disorder: Are We Getting It Wrong?
https://www.psychologytoday.com/blog/sleep-newzzz/201305/adhd-or-sleep-disorder-are-we-getting-it-wrong
