Dr. Meir Kryger (Co-author of Principles and Practice of Sleep Medicine) once told me that in 1970 – Obstructive Sleep Apnea (OSA) was considered so rare that he was asked to give a grand rounds on it to his medical school. It was then considered a rare disease of fat old men. NO LONGER. Science has improved.
OSA is a genetic problem. It occurs in men, women, and children. AND you don’t have to be fat or sleepy to have health impairing severity.
The overall frequency of OSA in children is 2%, but certain subgroups have a higher probability. These groups include:
- Children with parents having OSA
- Children who snore
- Children who were born prematurely
- Obesity
- Hypertension
- ADHD/ADD
- Genetic Disorders such as:
- Down’s syndrome
- Achondroplasia
- Prader-Willi Syndrome
If a child or adolescent snores on a regular basis and has any of the complaints or findings below the clinician should either obtain a PSG or refer the child to a sleep specialist or otolaryngologist for a more extensive evaluation.
- Frequent snoring (≥3 nights/wk.)
- Labored breathing during sleep
- Gasps/snorting noises/observed episodes of apnea
- Sleeping in a seated position or with the neck hyperextended
- Cyanosis
- Headaches on awakening
- Daytime sleepiness
- Attention-deficit/hyperactivity disorder
- Learning problems
- Physical findings of the following:
- oUnderweight or overweight
- Tonsillar hypertrophy
- Adenoidal facies
- Micrognathia/Retrognathia (Small or pushed back lower jaw)
- High-arched palate
- Failure to thrive
- Hypertension
- Paradoxical breathing
Children with OSA differ from adults with OSA in the following ways:
- Sleepiness is less frequent in children with OSA –being present in only10%.
- Obesity is less common.
- Obstructive events are less easily recognized. The snoring is often without the obvious pauses or arousals seen in adults.
In summary, children are harder to diagnose than adults. It pays to be vigilant both for their health and their future success in school.
Written by Dr. Steve Zorn, MD.