Screen / Test Your Child / Teen for Major Pediatric Sleep Disorders:

Bed-Wetting

Excessive Daytime Sleepiness

Insomnia

Narcolepsy

Periodic Limb Movement Disorder

Restless Legs Syndrome

Sleep Talking

Sleep Terrors / Night Terrors / Nightmares

Sleep Walking

Snoring

Teeth Grinding

Sleep Apnea
Sleep Disorders - Keyword Definitions
Obstructive Sleep Apnea (OSA)
See Obstructive Sleep Apnea Syndrome (OSAS)
Obstructive Sleep Apnea Syndrome (OSAS)
Most parents are unaware that many daytime and nighttime behavior problems such as a child resisting sleep, child waking at night, kicking or moving in sleep, night terrors or sleep terrors, bed-wetting, daytime sleepiness, lethargy, lack of motivation, depression, irritability, tantrums, excessive frustration, and hyperactivity could be caused by Obstructive Sleep Apnea Syndrome. Obstructive Sleep Apnea Syndrome is such a serious sleep disorder that it can cause or exacerbate many behavioral disorders, such as Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder, Bipolar Disorder, Anxiety Disorder, Depression, and many other problems. A high percentage of children with Autism have many sleep problems, including OSAS. Because of these problems, many students with OSAS have learning disabilities, developmental delays, behavioral disorders, and some are even mentally handicapped in severe situations (which may be a result of oxygen deprivation to the brain and arterial blood flow). Because of its negative impact on the body and emotional well-being, it is important that every child with any of the above-mentioned problems should be screened or assessed for Obstructive Sleep Apnea Syndrome (OSAS). If your child has any of these sleep or behavior problems and exhibits raspy breathing at night, mild snoring, or very loud snoring, please read the information below on OSAS and how you can do a sleep screening on your child/teen for OSAS and other major pediatric sleep disorders:

Obstructive Sleep Apnea Syndrome is a sleep disorder where the person stops breathing for at least 5-to-10 seconds, numerous times per hour, while asleep. In children, these breathing pauses must occur approximately two times per hour when asleep, and for adults, the criteria are at least five times per hour breathing pauses for more than 10 seconds each time. OSAS is much more frequent than Central Sleep Apnea (Central Sleep Apnea is not caused by an obstruction in the airways preventing breathing, but by the brain not commanding the lungs to breathe regularly when asleep).

If studied carefully in a sleep lab by polysomnography, approximately 1 in 5 American adults has at least mild OSAS. At least 2-3% of children under 9 years of age have OSAS, and possibly as high as 4-6% of adolescents have OSAS. Since the muscle tone of the throat ordinarily relaxes during sleep, and since the human airway is composed of walls of soft tissue, which can collapse, it is easy to understand why breathing can be obstructed during sleep - particularly in people who are obese, have a larger than normal tonsil, adenoid, or tongue size (as seen in persons with Downs Syndrome), or unusual craniofacial abnormalities (i.e., cleft palette, narrow jaw structure, recessive chin, etc…). Although many individuals experience episodes of obstructive sleep apnea at some point later in life, a much smaller percentage of people are afflicted with chronic severe obstructive sleep apnea.

Normal sleep has four stages of Non-Rem sleep which range from light to deep. Following NREM comes REM sleep (your dreaming stage). The deeper stages are required for the restorative effects of sleep, but are also the stages during which the muscle tone of the throat and neck is most reduced. If the airway collapses in deep sleep when muscles relax, either arousal to a lighter stage of sleep or awakening occurs. In severe cases of obstructive sleep apnea, very little time is spent in deep sleep and the result is sleep deprivation, no matter how many hours are spent sleeping in the lighter stages. The person still feels tired much of the day or irritable.

Many people experience obstructive sleep apnea for only a short period of time. This can be the result of nighttime allergies, asthma, an upper respiratory infection that causes congestion and nasal obstruction, along with swelling of the throat, or tonsillitis that temporarily produces enlarged tonsils. Sporadic episodes of OSAS may also occur in individuals who are under the influence of a drug (such as alcohol) that may relax their body tone excessively and interfere with normal breathing at night.

Symptoms of OSAS include:

· Snoring (the most common)
· Belabored breathing while sleeping
· Choking, snorting, or gasping for air
· Restless sleep including rolling or kicking around or sleeping in unusual positions
· Changes in color if breathing subsides for a longer period of time

A child or adult with these symptoms should be referred to their physician or a sleep specialist for an examination of their airways and possibly an overnight sleep study, the objective method of diagnosing OSAS and assessing the type of treatment needed to correct it.

Because OSAS may disturb sleep patterns, these children may also show either characteristics of Attention Deficit/Hyperactivity Disorder (ADHD) or continued sleepiness after awakening in the morning, tiredness, and attention problems throughout the day. Excessive Daytime Sleepiness (EDS) is a key feature of OSAS resulting from disrupted sleep. Frequently OSAS negatively affects school performance due to the lack of alertness and concentration in these children, and possibly due to some oxygen deprivation occurring when breathing subsides. Recent studies suggest that a significantly higher percentage of children in special education classes have sleep disorders such as OSAS, and their learning and/or behavior problems decrease after the sleep disorder is corrected. Furthermore, children diagnosed with ADHD actually have attention problems in school because of disrupted sleep patterns caused by OSAS or Periodic Limb Movement Disorder (PLMD).

Toddlers and young children with mild-to-moderate OSAS ordinarily behave as if "hyperactive" or irritable. Adults and older children with severe OSAS are often excessively tired in the daytime. They may also differ in typical body characteristics. Adults may be heavier, with particularly short and heavy necks. Young children, on the other hand, are generally not only thin, but a few may have "failure to thrive", where growth is reduced. Poor growth occurs for two reasons: continuing breathing is hard work so that calories are burned at high rates even at rest, and the nose and throat are so obstructed that eating may be both tasteless and physically uncomfortable. OSAS in children, unlike adults, is almost always caused by obstructive tonsils and adenoids and is usually cured with tonsillectomy and adenoidectomy (surgical removal of tonsils and adnoids). In some older children and adults, sleep specialists often recommend continuous positive airway pressure (CPAP), which involves having the patient wear a nose mask while sleeping.

Additional signs of OSAS include morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, increased heart rate or high blood pressure, anxiety, depression, increased frequency of urination, bedwetting and heavy sweating at night.

The most serious consequence of OSAS is to the heart. In severe and prolonged cases, there are increases in pulmonary pressures that are transmitted to the right ventrical (right side) of the heart. This can result in a severe form of congestive heart failure (cor pulmonale).
Overnight Sleep Study / Polysomnography
An overnight sleep study measures what happens to the body of a person during sleep. The study is done to find out what is causing a person’s sleep problems. This evaluation is painless and helps the sleep specialist understand why the patient is having difficulty sleeping, snoring, or is excessively tired during the daytime. A person is usually referred to a sleep center by a physician where a polysomnogram (PSG) is conducted. Polysomnography is a comprehensive recording of the bio-physiological changes that occur during sleep. This diagnostic test monitors many body functions, including breathing or respiratory effort during sleep, brain waves (EEG) and time spent in the five different stages of sleep, eye movements (EOG), leg muscle activity (EMG), and heart rhythms (EKG).

EEGs are measured by attaching four electrodes to the scalp, providing a readout of the brain activity during the various levels of sleep (1,2,3,4, REM and wakefulness). The EOG consists of two electrodes placed slightly outside and below the outer canthus of each eye. They measure when REM (Rapid Eye Movement) – sleep occurs.

The EMG measurements often consists of four electrodes attached to measure muscle tension in the body (particularly the legs and chin, which can give answers to when sleep occurs, as well as REM sleep, similarly to the EOG) and monitor for an excessive amount of leg movements during sleep, which may be indicative to Periodic Limb Movement Disorder (PLMD).

The EKG measurements consist of three electrodes attached to record the electrical activity of the heart to determine any possible underlying heart problems.

A specialist will interpret the PSG recordings, and the results will be communicated to the physician requesting the test within a week or two.
 
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