Fact Sheet: School Age Screening for Sleep problems in Youth Sleep Disordered Breathing (SDB) Problems
- Obstructive: large adenoids / tonsils, or tongue displaced back into an airway
- environmental: allergies or chronic sinusitis
- genetic: mismatched, narrow jaws
- anatomic/structural: misaligned jaws or airway dysplasia
Mouth-breathing, loud snoring, tossing and turning, and gasping and choking during sleep are observed. Attention difficulties, unpredictable behavior at school (even depression) may be related to lack of restful sleep. A child’s mood is often not happy, while looking tired and sad. Mood can change from teary to explosive.
Obstructive sleep apnea increases the risk of heart disease, stroke and diabetes. Bed-wetting, sleep-walking, diminished growth, hormonal, metabolic problems, and narrow dental arch problems are common. Insufficient sleep in the youngster’s formative years is associated with metabolic, cognitive and emotional behavioral effects. Pediatric sleep-disordered breathing is a growing area of interest. Kids can fall through the diagnostic cracks when this is not recognized and managed.
25% of ADHD problems are children deprived of restful sleep and thus behavioral problems. Sleep-disordered breathing in first five years of life associated with 40 to 60% greater chance of special educational needs by age 8.
Awakening parental awareness
The American Association of Pediatrics “Practice Parameters” recently stated that all children should be screened for snoring because of the 70% overlap of snoring and sleep apnea. The numbers are staggering! Sleep-disordered breathing is underdiagnosed, and often clinicians take a wait-and-see approach with the hope that a child will outgrow it. Invasive interventions are needed to correct the problem later. The child suffers lessened quality of life, behavioral and/or learning challenges unless helped to restore normal breathing and sleep.
A simple patient questionnaire and selective 3-D images of a child’s airway helps identify restrictions. Facial orthopedics can help to open the airway, with teamwork by medical and dental sleep specialists for related treatments to optimize the airway and sleep quality.
Patients may benefit from a home sleep study, or see an otolaryngologist (ENT) if large tonsils or adenoids need to be removed. Some simply need allergy meds. A common approach may be simple upper jaw orthopedic expansion to correct narrow jaw, or lower jaw lengthening with widening of the dental arches. Within weeks / months, the child typically rests better and awakens normally.
Studies show a strong association between pediatric sleep disorders and childhood obesity. Weight management, oral appliances, or positive airway pressure (PAP) therapy are very effective treatments. Bruxism (teeth grinding) occurs during restless sleep and causes primary teeth to become worn –a direct connection with sleep-disordered breathing. Also, sleep-deprived kids may have a lisp caused by inadequate tongue space and poor teeth alignment, chronic dark circles under the eyes, difficulty waking up in the morning, irritability, fidgety behavior, mouth breathing, and recurrent episodes of nasal congestion.
Do the right thing to help each child
Clinicians and parents can do harm by doing nothing. The key factors are recognizing and preventing airway problems and breathing conditions when the child is younger. We each feel, perform, and behave our best when rested.
Website info: http://www.spokanesleepapneanetwork.com/pediatric-sleep-apnea
Contact any of these professionals for simple screening and proper guidance for your child.
Dr. Duane Grummons Board Cert Facial Orthopedics/Orthodontics
Dr. Jeffrey Schilt, Nurse Practitioner mtspokanepediatrics.com