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Sleep Apnoea in Children Misdiagnosed as ADHD

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Your child has been “playing up” at school, he has poor concentration, he bounces between exhaustion and hyperactivity and his teachers are getting concerned. They recommend testing with a GP or psychologist for Attention Deficit Hyperactivity Disorder. Genuine cases of ADHD can be controlled through medications, dietary changes and therapy – but before you head down this long and difficult path, it’s worth considering other causes of difficult behavior. Sleep Apnoea is one, a relatively common one too. In fact up to 25% of men and 9% of women are estimated to suffer from sleep apnoea. (source)

What is Sleep Apnoea exactly?

Obstructive Sleep Apnoea is a condition where the patient rouses from sleep because of airway obstruction. It’s most common in the elderly, obese or pregnant but children can also be affected. The shape and size of the child’s tongue, chin, tonsils, adenoids and soft palate can determine their likelihood of developing the condition. In addition to behavioural issues, Obstructive Sleep Apnoea can lead to serious health issues including heart disease, high blood pressure, stroke and depression – so it’s worth getting a diagnosis early.

The symptoms to watch out for

Simply watching your child sleep can give clues to whether they’re a candidate for OSA. Your child may be suffering from Obstructive Sleep Apnoea if they:

  • snore
  • gasp or choke in their sleep
  • rouse suddenly
  • suffer insomnia
  • suffer headaches in the morning
  • have frequent sore throats
  • wet their bed
  • rapidly gain weight or struggle to maintain a healthy weight
  • experience a slow growth rate or “failure to thrive”
  • have nightmares
  • have an inward movement of the rib cage
  • suffer halitosis

Diagnosis and treatment for Sleep Apnoea in Children

If you notice these symptoms, it’s time to head to your GP for advice. Your GP will likely refer your child to a sleep clinic where his sleep will be monitored overnight for issues. Remember to take your child’s favourite bed time toy to make it easier to sleep well in the strange environment and greet him with breakfast in the morning (many hospital based sleep clinics simply wake you and discharge you without any creature comforts!)
If they’re found to have Obstructive Sleep Apnoea, you may be referred to an Ear, Nose and Throat specialist (for removal of tonsils or adenoids), a pediatrician for management of weight or other physical issues or a dentist or orthodontist. Your dental professional will explore options for straightening teeth and widening dental arches. For teens, your dentist may also recommend a night time oral appliance (like a mouth guard) to better align your child’s jaws.

Continuous Positive Airway Pressure (CPAP) Machines

Continuous Positive Airway Pressure is a machine worn like old fashioned dental “head gear” and applies pressure to airways keeping them open. They’re not commonly used on young children but may be an option for older teens. These machines can be very obstructive and difficult to become accustomed to using at night. These have long been the most effective treatment for OSA but in recent years, dental technology has come ahead. It’s worth trying a smaller, simpler, less obstructive oral appliance first. Ask your dentist or orthodontist for options and more information.

The outlook for children suffering sleep apnoea

Early diagnosis of Obstructive Sleep Apnoea will greatly improve your child’s chances of avoiding long term, serious health issues. Children incorrectly diagnosed with ADHD, delaying proper diagnosis may be at risk for life long challenges. With treatment, Sleep Apnoea can be cured or at least effectively managed through medical and dental intervention. Who knew watching your child sleep for just a few hours could change their whole life!

This is a contribution by Brisbane Dentist Robert Duhig. At his Sandgate based practice, Robert Duhig assists adults and children to overcome sleep apnoea, improving their health for life.

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