Pediatric Sleep Apnea

Why is my orthodontist asking about my child’s sleeping or behavior? Don’t they just straighten teeth?

Not at all. We are realizing that orthodontic care can make a big difference in overall health. OSA (Obstructive Sleep Apnea) and SDB (Sleep Disordered Breathing) have largely gone unrecognized in children but can have serious implications.

Causes

The most common and significant are:

  • Obstructive tissues (enlarged tonsils, adenoids, turbinate bones (in the nose), deviated septum)
  • Lack of room for the tongue (narrow jaws, recessive upper or lower jaws, tongue-tied)

Does My Child Suffer from Obstructive Sleep Apnea (OSA) or Sleep Disordered Breathing (SDB)?

OSA and SDB have largely gone unrecognized in children but can have serious implications. They can contribute to growth problems, failure to thrive, Type 2 Diabetes, ADD, ADHD, autism, hypertension, stroke and cardiovascular disease.

Child Sleep Habits Questionaire

Pediatric Sleep Questionaire

Symptoms of Pediatric Obstructed Sleep Disorders

Night Time

  • Loud breathing noise rather than distinct snoring (occasional snoring)
  • Mouth breathing
  • Increased sweating
  • Unique events that occur during sleep i.e. sleepwalking, sleep talking
  • Restless sleep
  • Bedwetting

Day Time

  • Difficulty in awakening
  • Mouth Breathing
  • Disturbances of concentration
  • Difficulties with focused attention
  • Decreased performance in school
  • Behavioral difficulties; motor restlessness
  • Low threshold to express negative emotion (irritability and easy frustration)
  • Difficulty controlling impulses and emotions
  • Chronic daytime sleepiness

Attention Deficit Hyperactivity Disorder or Obstructed Sleep Apnea

  • Pediatric obstructed sleep apnea is often misclassified as an attention deficit hyperactive disorder/attention deficit disorder (ADHD or ADD)
  • Consider an evaluation for sleep breathing disorder in children diagnosed with ADHD/ADD

Consequences of Undiagnosed or Untreated Childhood Obstructed Sleep Apnea

  • Impaired growth/neural (brain) development
  • Learning and memory disabilities
  • Behavioral problems
  • Premature hardening and narrowing of the arteries
  • Bedwetting
  • Increased blood pressure
  • Changes of shape and structure of the heart
  • Plaque build up in the arteries
  • Cardiac Arrest
  • Systemic inflammatory response (bodys immune response to a noninfectious insult)

Child Sleep Related Breathing Disorders

The following conditions raise the index of suspicion for pediatric sleep related breathing disorders:

  • Enlarged tonsils and adenoids
  • Obesity
  • Snoring
  • Dental cross bites due to constricted upper jaw and teeth
  • Receding lower jaw and teeth
  • Chronic obstructed nasal airway (stuffiness)
  • Diagnosis of ADD/ADHD or signs and symptoms similar to those of ADD/ADHD

Management Strategies

Your orthodontist with advanced training in sleep disorders is a great place to begin sleep and related malocclusion evaluations.

What happens physiologically

With improper breathing, blood oxygen decreases and carbon dioxide increases. This triggers release of cortisol (the fight or flight or survival stress hormone) that increases heart rate and activates muscles to force breathing. Although the person doesnt actually wake, they are driven from deep restorative sleep to catch their breath. Once they begin to relax to the deeper levels of sleep, it happens all over again. This is hard on the body like running a race all night long. You wake up exhausted and unrested, but more importantly, prolonged levels of increased cortisol negatively affects the immune system, normal hormone production, insulin function, gastric acid production, and learning and memory retrieval, and a host of other organs and body functions.

What are the implications of decreased O2 in a growing and developing brain of a child?

We now know that any airway resistance is not healthy and can be harmful to the developing brain- it makes it difficult or impossible to store the information they learned today into long-term memory.

Diagnosis

Sleep Questionnaire, Clinical Examination, 3D imaging, Home sleep testing, Overnight Sleep Study

Treatment Strategies for Children

  • Removal of tonsils and adenoids after ENT evaluation by an ENT M.D.
  • Anti-inflammatory therapies to help open obstructed airway by an ENT M.D.
  • Correction of chronic nasal obstruction by an ENT M.D.
  • Expansion of the upper arch with a palate expansion appliance by an orthodontist
  • Intra-oral mandibular (lower jaw) repositioning appliances by an orthodontist. Historically used in orthodontics to enhance the forward growth and development of the lower jaw in children with a receding lower jaw.
  • Continuous positive airway pressure (CPAP) by a sleep physician
  • Surgical reconstruction of skeletal deformities by an oral surgeon

When to assess and treat?

As soon as you are aware of the problem! Although 7-8 years of age is an important age for orthodonticcorrection, we can make a big difference in 3- to 6-year olds with some simple and timely care.

For our practice, Orthodontics is MUCH more than straight teeth

Child Sleep Habits Questionaire

Pediatric Sleep Questionaire