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
Symptoms: 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. 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 cognitive, behavioral, metabolic, cardiovascular and endocrine effects which may have long-term implications, well into adulthood. (Capdevila, Oscar Sans, et al. “Pediatric obstructive sleep apnea: complications, management, and long-term outcomes.” Proceedings of the American Thoracic Society 5.2 (2008)) Kids can fall through the diagnostic cracks when this is not recognized and managed.
25% of children with ADHD problems are deprived of restful sleep, thus exhibiting behavioral problems that are virtually indistinguishable from ADHD .”Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep.” –http://www.sleepapnea.org/treat/childrens-sleep-apnea.html)
Sleep-disordered breathing in first five years of life is associated with 40 to 60% greater chance of special educational needs by age 8. (Bonuck, Karen, Trupti Rao, and Linzhi Xu. “Pediatric sleep disorders and special educational need at 8 years: a population-based cohort study.” Pediatrics 130.4 2012)
Awakening parental awareness
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 a lower quality of life, as well as 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.
|Emphasis is upon childhood recognition of these problems with intervention early to normalize breathing, jaw development, brain and behavioral development. This childhood treatment time window is critical for conservative options to be successful. A narrow upper jaw or short lower jaw can predispose children to sleep-disordered breathing. Orthopedic upper jaw expansion or lower jaw advancement may be effective treatments.
(Source: Huynh et al “Orthodontics treatments for managing obstructive sleep apnea syndrome in children.” Sleep Med Rel 25 20164)
We each feel, perform, and behave our best when rested;
this is true for all ages!
Spokane Regional Sleep Apnea Network:
Contact any of these professionals for simple screening and proper guidance for your child:
Dr. Duane Grummons, Board Certified in Facial Orthopedics and Orthodontics
Dr. Jeffrey Schilt, Nurse Practitioner mtspokanepediatrics.com
Dr. Steven Olmos firstname.lastname@example.org