Children and Sleep Disordered Breathing

Sleep Apnea and Sleep Disordered Breathing (SDB) are taken very seriously in adults but children have long been undertreated.  This year at both the Dental Sleep Meeting AADSM and the Sleep Meeting AASM numerous lectures were given on the need for early and definitive treatment of sleep disordered breathing in children.

Tonsil and Adenoid removal has long been the first line of treatment.  Several studies showed that just T&A is not always a cure.  Every child should have a follow-up study to ensure SDB is resolved.

Tand A after age 7 will probably require the addition of CPAP or an oral appliance.  The earlier the airway obstruction is corrected the faster the return to normal growth patterns.  Epigenetic orthodontics can correct altered growth that resulted from obstructive tonsils and adenoids.  Rapid Maxillary Expansion (RME) is often utilized in children to increase the airway (pneumopedics) but as the child ages becomes less effective.  In adults RME may require a surgical assist.

How young is too young for T&A?  4 years old or earlier. 1 1/2 - 2 years old  may be ideal.  There is also the question whether maxillary expansion should precede T&A surgery.  There is good evidence that a larger airway leads to faster healing and less risky surgery.  In some children surgery may be avoided.

The most important item is to never ignore poor sleep, early morning awakenings, excessive nocturnal sweating , hyperactivity or mild snoring in children as it can create permanent changes in growth and development as well as changes in mental development and brain maturation.  The American Academy of Pediatric Medicine says there is no acceptable level of sleep apnea in children and that all pediatric snoring should be evaluated.