Diagnosing Sleep-Disordered Breathing in Children
Many HME providers are familiar with the nuances of sleep apnea in adults. A new trend in sleep, however, shows that many children — pediatrics and adolescents — show a high prevalence of sleep apnea.
Sleep-disordered breathing in children also presents slightly differently than adult sleep apnea. Unlike adults, children generally present with hyperactivity rather than daytime sleepiness, according to a study recently published in the journal SLEEP.
"This estimated prevalence of SDB is a somewhat higher than recent SDB estimates from population-based studies of children using traditional polysomnography clinical thresholds and about the same as those found in adults in Western countries, suggesting that this self-report measure, while lacking the validity of polysomnography, is not an unrealistic one for adolescents," wrote Eric O. Johnson, Ph.D., of Research Triangle Institute International in Research Triangle Park, N.C.,, the study's author.
SDB has also been shown to impair physical and mental development, leading to cognitive deficits.
According to the National Center on Sleep Disorders Research and the National Heart Lung and Blood Institute, snoring, a symptom of increased upper airway resistance during sleep, is extremely frequent in children. The statistics show that snoring affects 18-20 percent of infants, 7-13 percent of children ages 2-8, and 3-5 percent of older children.
Further research is still needed to fully understand the pathophysiology of SDB in children. Obesity is definitely a risk factor, and the rise of childhood obesity in the United States could exacerbate the problem.
The American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Va., cites the following consequences of untreated pediatric sleep-disordered breathing:
- Snoring
- Sleep deprivation — Children may become moody, inattentive and disruptive both at home and at school. Classroom and athletic performance may decrease along with overall happiness. Children will lack energy, often preferring to sit in front of the television rather than participate in school and other activities. This may contribute to obesity.
- Abnormal urine production — SDB also causes increased nighttime urine production, and in children, this may lead to bedwetting.
- Growth — Growth hormone is secreted at night. Those with SDB may suffer interruptions in hormone secretion, resulting in slow growth or development.
- Attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD) — Research suggests that sleep disordered breathing is a contributing factor to attention deficit disorders.
Many times children with SDB are prescribed medications to treat ADD or ADHD. To address snoring, many children undergo tonsillectomies and/or adenoidectomies, which offer a 90 success rate according to the American Academy of Otolaryngology-Head and Neck Surgery. Still, the National Center on Sleep Disorders Research and the National Heart Lung and Blood Institute assert that this treatment had measurable morbidity, mortality and financial costs.
Children who are not candidates for this procedure or whose symptoms persist after these procedures may benefit from CPAP therapy. For children around the age of 8 or older, a standard adult CPAP and a small adult mask may work perfectly. For younger children, a specialized VPAP device allows the HME provider to customize treatment for an individual. Infants and very young children may require a nasal cannula for treatment.
To help parents understand the risks associated with untreated sleep apnea, the industry must work to increase awareness among this population.
This article originally appeared in the March 2007 issue of HME Business.