PEDIATRIC SLEEP DISORDERED BREATHING
Sleep disordered breathing (SDB) represents a spectrum of disorders including snoring, upper airway resistance syndrome, obstructive hypoventilation and, at the extreme end of the spectrum, obstructive sleep apnea syndrome. Certain behavioral and developmental problems in children have been shown to be related to SDB including ADHD, poor school performance, neurocognitive impairment, enuresis, and daytime somnolence.1,2 Adenotonsillectomy (T&A) is potentially curative for the whole spectrum of sleep disordered breathing.3
Although polysomnography (PSG) is considered the gold standard for the diagnosis of obstructive sleep apnea, PSG may not be appropriate for routine use in screening for SDB in children. In one survey among otolaryngologists, less than 5% of school aged children received PSG before undergoing T&A. Reasons for such low usage includes cost and availability of sleep centers that can accommodate children. More importantly, there is not enough normative data on PSG in children to allow for accurate results based on the apnea-hypopnea index. Also, several studies demonstrate that there is not necessarily a direct relationship between the severity of obstructive sleep apnea syndrome (OSAS) as measured by AHI, and the degree of associated behavioral and developmental impairment. Some children may have a normal sleep study but still have significant SDB in the form of snoring or upper airway resistance syndrome that is contributing to impairment.3
Two questionnaires that the physicians at Raleigh Capitol ENT have found to be helpful are the OSA-18 and the pediatric sleep questionnaire (PSQ). The OSA-18 is a validated, disease specific quality of life (QOL) survey consisting of 18 questions.4 Parents are asked to rate each issue on a scale of 1 to 7 and then a total score is calculated. The PSQ also can be used to identify children with sleep related breathing disorders (SRBD). 5 Parents are asked to indicate which questions describe their child’s sleep or behavior. Eight or more positive responses suggest a high risk for SRBD. Adenotonsillectomy has been shown to normalize sleep parameters in up to 83% of pediatric patients with SRBD.1 Children with the combination of a positive OSA-18 or PSQ and physical exam demonstrating tonsil and/or adenoid hypertrophy may be adequate to identify those that will benefit from T&A. Raleigh Capitol ENT is pleased to offer this treatment at our six convenient locations.
- Garetz,S. Behavior, cognition and quality of life after adenotonsillectomy for pediatric sleep disordered breathing.
Otolaryngology-HNSurgery 2008;138, S19-26
- Beebe, D. Neurobehavioral morbidity associated with disordered breathing
during sleep. Sleep 2006;29(9): 1115-11134
- Wei, J., et.al. Improved behavior and sleep after adenotonsillectomy in children with sleep disordered breathing. Arch Oto/HNS 2007; 133(10):974-979
- Franco,Jr., R., et.al. Quality of life for children with obstructive sleep apnea.
Oto-HNS 2000; 123:9-16
- Chervin,R., et. al. Pediatric sleep questionnaire (PSQ): validity and reliability scales for sleep-disordered breathing, snoring, sleepiness and behavioral problems. Sleep Medicine 2000; 1:21-32