May 01, 2009

Is Your Child Acting Out? It Might Be a Sleep Disorder

Jay Reeck, MD, ENT, recalls one distraught mother who stayed with her child all night and, every time he stopped breathing, she would give him a little nudge to wake him up.

It was obstructive sleep apnea (OSA), a disorder that blocks the airway, causing wakeful, restless sleep. A child with OSA may stop breathing for a moment, but will awaken and start to breath again. "It really scares parents," says Reeck. "And it is appropriate for them to seek care."

A pediatric sleep study at the Rogue Valley Sleep Center diagnosed the child with  OSA. A pediatrician sent him to Dr. Reeck, who removed the child's tonsils and the OSA stopped. "It's great to have parents come back and say, ‘Oh my gosh, they are sleeping so well!' It's amazing to see their faces just light up," says Reeck.

Obstructive sleep apnea affects about 1-3 percent of children. It leaves adults tired and droopy all day. But it often has the opposite effect in children, causing symptoms that mimic attention deficit hyperactivity disorder (ADHD).

"If a child is snoring, he might be arousing multiple times a night and have fragmented sleep," says Lee Harker, MD, pediatric sleep specialist and Chairman of Women and Children's Services at RVMC, "Poor sleep affects school performance and certainly can result in behavior problems. A good night's sleep is just as important, if not more important for kids."

The Rogue Valley Sleep Center in Medford is now offering sleep studies for children, the only pediatric program in the region. A primary doctor may refer a child for a sleep evaluation and sleep study, or to an ear nose and throat (ENT) physician and surgeon.  

"We are now seeing children ages 3-17," says Annemarie Day, a family nurse practitioner with Pulmonary Consultants & Sleep Specialists, a physician group that works with Rogue Valley Sleep Center. Day recommends seeing one's physician, who can help with a sleep questionnaire and then make a referral.

Children with sleep disorders may show symptoms such as excitability, irritability, difficulty staying focused on tasks or school activities, and poor attention span. Children with upper airway restriction may not snore like adults. Instead, they may have raspy breathing or sound congested while sleeping.

"But they often do snore," says Harker. "And is there such a thing as healthy snoring?"
 
There are many childhood sleep disorders, the most common being sleep apnea, sleep hygiene issues, sleep terrors, sleepwalking and other parasomnias. "And the people at Pulmonary Consultants and the technologists at Rogue Valley Sleep Center are very well trained and prepared to help," says Harker.

"We can diagnose all pediatric sleep disorders," says Beth Mortonson, Clinical Manager of Rogue Valley Sleep Center. "And we have seen remarkable turnarounds in the behavior of children treated for sleep apnea." 

To get a sleep study for your child, contact your physician. For more information, call the Rogue Valley Sleep Center at (541) 774-5750.

Can it Affect My Child's Health?

A child with OSA may have poor health and growth, difficulty concentrating and/or developmental delay, hyperactivity and behavioral problems.

"When you pick up a healthy, sleeping child, she may be like a limp rag," says Annemarie Day, FNP, a pulmonary specialist. "That child is in deep sleep and that releases hormones necessary for growth and building muscle." A child with sleep apnea may never be able to reach or maintain deep sleep, preventing the release of growth hormone and making his or her heart work overtime by constantly speeding up to try and overcome the apnea so they can breathe.   

Is a Sleep Study Really Necessary?

Even if a sleeping disorder is strongly indicated, a parent should get a sleep study for her child before seeking treatment, recommends Lee Harker, MD., neonatology, Newborn Critical Care Associates.  Harker screens child sleep referrals to ensure proper testing and diagnosis.

"With a proper diagnosis, insurance is more likely to pay for an overnight stay after a tonsillectomy," Harker explains. Recent studies have shown that children with sleep apnea are particularly susceptible to serious complications after tonsillectomy. "That first night can be pretty rocky," Harker continues, "Kids with sleep apnea definitely warrant closer monitoring. I recommend you discuss having a sleep study with your doctor. If your child has true sleep apnea then he or she should be watched overnight in the hospital after surgery."

So, What is Child Obstructive Sleep Apnea?

Jay Reeck, MD, often treats children with obstructive sleep apnea. According to Reeck, sleep apnea can affect a child's health and, "Paradoxically, cause hyperactivity instead of sleepiness during the day."

Here are some facts about sleep apnea he says parents should know.

What it is

Childhood obstructive sleep apnea (OSA) is characterized by episodic upper airway obstruction that occurs during sleep.
In children, if obstruction occurs with 2 or more consecutive breaths, the event can be called an apnea.

Frequency

In non-obese and otherwise healthy children younger than 8 years, the prevalence of obstructive sleep apnea is estimated at 1-3 percent. Most children with obstructive sleep apnea are aged 2-10 years. Obesity confers 4-fold to 5-fold added risk for sleep-disordered breathing.

Causes

Large tonsils and adenoids are the most common cause of obstructive sleep apnea in children. In this situation, removal of the large tonsils and adenoids is usually curative.

What to do if OSA is suspected

Parents should consult with their child's primary care provider for a referral to certified sleep experts such as Pulmonary Consultants & Sleep Specialists for evaluation and possible sleep study. If apnea is diagnosed, the child may be referred to an ear, nose, and throat (ENT) physician for further diagnosis and treatment. 

Attention Deficit Hyperactivity Disorder

Studies of children with OSA who meet ADHD criteria or have daytime behavioral problems show improvement in behavior and sometimes do not meet ADHD criteria after removal of the tonsils and adenoids. This should not be interpreted to mean that removing tonsils and adenoids cures ADHD.

A Dozen Signs Can Point to Sleep Disorder

Most children present with a history of snoring and difficulty breathing during sleep. The child sleeps restlessly, and may adopt bizarre sleeping positions. Enuresis (bed wetting) is common. The child's appearance during sleep can be so alarming that parents often continually stimulate or reposition the child throughout the night.

If your child exhibits any of the following symptoms, a sleep evaluation and/or study might be needed:

• Sleep in an abnormal position, with head off the bed or propped up with many pillows.
• Snore loudly and often
• Stop breathing during the night for a short period-followed by snorting or gasping or completely waking up
• Sweat heavily during sleep
• Have school or other behavioral problems
• Sleep restlessly
• Are difficult to wake up, even though sleep should have been long enough
• Have headaches during the day, particularly in the morning
• Are irritable, aggressive, or simply "cranky"
• Fall asleep or daydream in school or at home
• Have attention deficit disorder with hyperactivity (ADHD)
• Bedwetting that isn't outgrown at a typical age, especially if snoring is present