Sleep matters

Study finds up to 15% of children have sleep apnea, yet 90% go undiagnosed

Symptoms of sleep-disordered breathing in children are often wrongly attributed to behavior issues, according to research in The Journal of the American Osteopathic Association.


Children are grossly underdiagnosed for sleep-disordered breathing (SDB), which includes obstructive sleep apnea (OSA), possibly because the symptoms often are wrongly attributed to behavior issues, according to research 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 percent more than the general population.

Up to 15 percent of children have some form of sleep-disordered breathing. However, 90 percent 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,” says John White, DDS, coauthor on this study.

Researchers explain that neurocognitive development, cellular regeneration, and tissue and bone growth all occur during the deep sleep stage. 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.

Symptoms to look for

Symptoms of SDB and OSA in children include snoring, restless sleep, excessive sleepiness, teeth grinding and jaw clenching, migraines, bedwetting, and irritability. If SDB is suspected, White says a referral to a multidisciplinary team is ideal. This typically includes a pediatric ENT (ear, nose and throat specialist), sleep specialist, a dentist trained in craniofacial development, and a myofunctional therapist, who specializes in disorders of the muscles and functions of the face and mouth.

White says that dentists are often able to screen for the problem because it is rooted in dysfunctional craniofacial development, which begins early on. He explains that infants with tongue-tie or who have latching problems during breastfeeding might be at risk for developing SDB or OSA, as well as children who have speech delays.

“A lot of airway problems come from poor jaw structure,” says White. “And the tongue is crucial in shaping the mouth, jaw and nasal cavity.”

Treatment options

For children who are diagnosed with SDB or OSA, the first line of treatment is usually removing the child’s tonsils and adenoids, according to White. If SDB persists following surgery, dentists might employ an orthodontic maxillary expander.

The device braces against the palate and top molars, with an adjustable bar bridging across the roof of the mouth. Parents turn a screw that extends the bridge one notch each week, over six to seven weeks. In that time, the roof of the mouth is expanded, increasing the volume of the nasal cavity and greatly improving respiratory patterns.

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

One comment

  1. Leah Welsh, DO

    I’m surprised this article does not mention osteopathic manipulation as an important aspect of multidisciplinary approach. if you’re not addressing underlying patterns of dysfunction, palate expansion has an increased risk of failure. 30% of orthodontic work needs to be repeated later in life. T&A can be avoided in some cases if OMM and myofunctional work are added early in the course of treatment.

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