Diagnosis of sleep disordered
breathing
The first diagnosis of sleep disordered breathing in
children is made by the parent’s observation of snoring. Other observations may
include obstructions to breathing, gasping, snorting, and thrashing in bed as
well as unexplained bedwetting. Social symptoms are difficult to diagnose but
include alteration in mood, misbehavior, and poor school performance. (Note:
Every child who has sub par academic and social skills may not have SDB, but if
a child is a serious snorer and is experiencing mood, behavior, and performance
problems, sleep disordered breathing should be considered.)
A child with
suspected SDB should be evaluated by an otolaryngologist – head and neck
surgeon. If the symptoms are significant and the tonsils are enlarged, the child
is strongly recommended for T&A, or tonsillectomy and adenoidectomy (removal
of the tonsils and adenoids). Conversely, if the symptoms are mild, academic
performance remains excellent, the tonsils are small, and puberty is eminent
(tonsils and adenoids shrink at puberty), it may be recommended that SDB be
treated only if matters worsen. The majority of cases fall somewhere in between,
and physicians must evaluate each child on a case-by-case basis.
There
are other pediatric sleep disorder diagnoses. Sudden infant death syndrome
(SIDS) and apparent life threatening episode (ALTE) are considered forms of
sleep disordered breathing. Children with these conditions warrant thorough
evaluation by a pediatric sleep specialist. Children with craniofacial
abnormalities, primarily abnormalities of the jaw bones, tongue, and associated
structures, often have sleep disordered breathing. This must be managed and the
deformities treated as the child grows.
The sleep test is the standard
diagnostic test for sleep disordered breathing. This test can be performed in a
sleep laboratory or at home. Sleep tests can produce inaccurate results,
especially in children. Borderline or normal sleep test results may still result
in a diagnosis of SDB based on parental observation and clinical
evaluation.
