DR. PAUL HANRAHAN
TOWNSVILLE ORTHODONTIC SPECIALISTS
Obstructive Sleep Apnoea (OSA) in Children
There is no doubt that many of us are not getting enough sleep and as any new parent will agree, sleep deprivation is a form of torture. Imagine how you would feel if you were woken from your sleep several times every hour for the whole night, every night, for years. This is what can happen to a child with Obstructive Sleep Apnoea (OSA).
Airflow can be almost completely obstructed for periods varying from a few seconds up to 30 seconds, several times every hour. This obstruction often results from collapse of the narrow airway behind the tongue and less oxygen reaches the blood. The chest wall heaves, a wheeze can be heard and the child does not have a deep restful sleep. In the short term, behavioural problems and learning difficulties may arise. In the long-term, cardiovascular problems can develop. Despite its media exposure, OSA is only a small part of the much larger field of Sleep Medicine and is not the same as snoring or ‘mouth-breathing’. The field of Sleep Medicine is a medical specialty involving the investigation, diagnosis and treatment of sleep abnormalities including OSA.
OSA can affect 3% of otherwise healthy children, affecting males and females equally, with a peak incidence from 2–6 years old. The risk factors include large tonsils and adenoids, obesity, neuromuscular conditions and craniofacial syndromes. Patients supposedly develop long ‘adenoid’ faces with ‘narrow’ palates, dental malocclusion including ‘cross bites’. Despite these claims, recent good quality research has shown that ‘not all OSA patients have altered facial morphology and not all patients with altered facial morphology have OSA’. There is no simple cause and effect relationship.
Dentistry has become involved in OSA, however, dentists cannot diagnose OSA. Dentists can be involved in screening for OSA using a clinical history and a PSQ (Paediatric Sleep Questionnaire), which is also available online. The definitive test is Polysomnography (a sleep test). Over diagnosing will often lead to unnecessary, expensive and ineffective over treatment. Under diagnosing may lead to serious future health problems.
It is best to have the diagnosis and treatment recommendations made by the true experts in the field – the Sleep Physician or Ear, Nose and Throat (ENT) Specialist.
Once accurately diagnosed, treatment options may involve weight loss, the removal of tonsils and adenoids, the prescription of anti-inflammatory nasal drugs, use of an oxygen mask at night (CPAP), or oral appliances to bring the lower jaw forward. Any oral appliance can cause changes in tooth position, which can result in orthodontic problems. Orthodontic treatment specifically for OSA (e.g. widening the top jaw with expanders or bringing the lower jaw forward) should only be considered when other medical treatments have failed and only on the recommendation of a specialist medical practitioner.
What should parents do?
Check your child after they have been asleep for a while. Spend five minutes watching for these signs:
• Do they snore?
• Do they breathe through their mouth?
• Do they stop breathing for periods greater than 10 seconds?
• Is their chest wall heaving yet still struggling for breath?
• Are they restless and sweaty during sleep?
• Are their daytime energy levels low?
• Are they hyperactive or having learning problems?
If you suspect that your child has any breathing abnormality, please consult with your local medical GP who can decide if referral to an ENT Specialist or a Sleep Physician is warranted. Referral from a medical practitioner will attract a Medicare rebate.
If orthodontic treatment is recommended by your medical practitioner, please see a registered specialist orthodontist.