Most Children With Sleep Apnea Go Undiagnosed

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Children are grossly underdiagnosed for sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA), and the symptoms may be wrongly attributed to behavior issues, according to research published in the Journal of the American Osteopathic Association.

Sleep apnea and related conditions can cause lasting damage to brain development during crucial years. As a result, children with undiagnosed SDB have been reported to use health care 226% more than the general population, according to the study.

Up to 15% of children have some form of SDB. However, 90% of those children go undiagnosed, often because symptoms are misattributed to psychological or emotional issues.

“Children who have behavior problems or are suspected to have ADHD might actually be suffering from a chronic lack of restorative sleep,” said John White, DDS, co-author of the study.

Neurocognitive development, cellular regeneration and tissue and bone growth all occur during the deep-sleep stage, according to researchers. However, when breathing is obstructed in the upper airway, the brain switches back from deep to light sleep in order to resume normal breathing, barring the mind and body from critical restorative processes.

Dr. White said that dentist are often able to screen for SDB because it is rooted in dysfunctional craniofacial development, which begins early in life. Symptoms of SDB and OSA in children include snoring, restless sleep, excessive sleepiness, teeth grinding and jaw clenching, migraines, bedwetting and irritability.

If a dentist suspects a patient has SDB, Dr. White recommends referring the patient to a multidisciplinary team that includes a pediatric otorhinolaryngology (ENT), a sleep specialist, a dentist trained in craniofacial development and a myofunctional therapist. For children who are diagnosed with SDB or OSA, the first line of treatment is usually removing the child’s tonsils and adenoids.

“Once we identify sleep apnea, treatment is usually very effective. The challenge is catching it early enough,” Dr. White said. “The early years are critical for brain development, so it’s essential that this condition is on our radar.”

Learn more about this study in Journal of the American Osteopathic Association (2019); doi: 10.7556/jaoa.2019.019.