If you suspect that your child has obstructive sleep apnea (OSA), you may want to consult first with your child's primary care provider (usually a pediatrician or family physician) and share your concerns. You may also choose to consult with an otolaryngologist (ear, nose, and throat specialist or ENT) or a pulmonologist (a specialist in lung problems) who deals with children. Sometimes, because of the hyperactivity, inattentiveness, aggressive behavior, irritability, and mood swings associated with pediatric OSA, a mental health provider, such as a child psychiatrist or psychologist, or a neurologist may be the first to recognize the problem. However, before seeing any specialist for an evaluation, you should check with your insurance company as you may need a referral or have to go to a specific provider.
Doctors who specialize in sleep medicine may also practice in your area. They have usually trained under other sleep specialists and/or studied sleep medicine through a residency program, continuing medical education (CME) courses, and scientific meetings. Physicians certified by the American Board of Sleep Medicine have passed standardized tests on both pediatric and adult sleep disorders. You should ask any doctor or health care provider about his/her credentials and experience, especially in dealing with children. You should be satisfied with the explanations and how it will be diagnosed and treated in your child's particular case.
In most cases, the initial evaluation for children with suspected OSA includes a complete medical history (symptoms; previous and current medical problems; operations, especially removal of the tonsils and/or adenoids; medications; and allergies), a review of any behavioral or developmental problems, a sleep history, and a physical exam (including weight and height). Blood tests, x?rays, and other specialized tests may be needed in some cases.
Based on the initial evaluation, your health care provider may suggest an overnight sleep study. A sleep study or polysomnogram can help to make a diagnosis of OSA in children and can help to judge the severity of the problem.
The recording devices used during a sleep study are similar in adults and children. These generally include an electroencephalogram (EEG) to measure brain waves and an electroculogram (EOG) to measure eye and chin movement, both to monitor the different stages of sleep; an electrocardiogram (EKG) to measure heart rate and rhythm; chest bands to measure breathing movements; and additional monitors to sense oxygen and carbon dioxide levels in the blood as well as monitors to record leg movement. None of the devices is painful and there are no needles involved, and sometimes the technician can attach the monitoring devices after the child has fallen asleep in the lab. Still the process may be a little frightening for a young child. Most sleep labs accommodate a parent's stay with the child overnight.
There are currently only a few clinics around the country that specialize specifically in pediatric sleep problems. However, many sleep study facilities (usually called sleep labs or sleep centers) perform studies on children as well as adults. Check first to make sure that the facility you use is equipped to handle children and that the sleep lab technicians are comfortable working with them. You should also ask if the doctor who will interpret the sleep study is familiar with reading pediatric sleep studies as they differ some from those of adults.
If you are not given a list of doctors and sleep testing facilities, you can find a referral from a few different sources. There is no one complete list of all such facilities, and as a non?profit organization, the American Sleep Apnea Association (ASAA) does not endorse or recommend any company, product, or health care provider. However, there is a list of sleep centers and laboratories accredited by the American Academy of Sleep Medicine (AASM) that pay their AASM membership dues. (The AASM, formerly known as the American Sleep Disorders Association or ASDA, is the professional society in the field of sleep medicine that accredits such facilities; accreditation implies adherence to a certain set of standards). The most up-to-date list of accredited member sleep centers and laboratories appears on the AASM's web site: www.aasmnet.org. You can request a list from the ASAA as well. Remember that other centers are in the process of being accredited, have chosen not to be accredited, or do not qualify for accreditation. You can also check with local hospitals and health care professionals to find a testing facility. It is technically possible to have a sleep study in the home, but home sleep studies have yet to be validated for children.
A different type of portable monitoring system has been approved by the Food and Drug Administration specifically for use in children aged five to seventeen. It can be used at home as well as in a sleep center but it does not gather some of the information that is obtained in a sleep center study. It is recommended that you check with your insurance carrier to see if they will pay for this type of study or pay for treatment based on a portable study.
OSA in children is a serious disorder that, untreated, may result in health problems as well as behavior and academic problems. Although common, OSA often goes unrecognized, but it can usually be easily treated if detected. Symptoms of pediatric OSA should not be ignored.
This piece is written for children age one or older who have not yet entered puberty and does not encompass infantile apnea or apnea of pre-maturity. As children begin to enter puberty, their symptoms--and hence the diagnosis and treatment of the disorder--become more like those of adults.
Some insurance policies specifically exclude the diagnosis and/or treatment of sleep disorders and some do not cover durable medical equipment (however, relatively few children are treated with durable medical equipment or DME; surgery is more common). Such coverage is worth considering when examining your policy and whenever thinking about changing your policy (such as during your employer's open season).
