Saturday, March 23, 2013

Signs of Childhood Sleep Apnea

Several people have asked what led to my request for a sleep study for Matthew. I thought I would write down some of the signs and symptoms that caused me to realize he had a high probability of having sleep apnea.

Firstly, Matthew has always had epic melt-downs. Particularly in the afternoon and early evening. Since this pattern is common in toddlers, I largely ignored it when he was younger. When the pattern continued at the age of six and seven years old, however, I knew something had to be causing the tears, anger, and inability to function past 3:00 pm.

Matt also has "tunnel vision" and it is impossible to get his attention. He obtains a glazed-eye appearance and you can call his name over and over again with no response. If you tap him on the shoulder, he will "snap out of it" and respond.

These two things would not be enough to definitively say he had sleep apnea, but I have a little secret to share.

When everyone else was shocked that Matt had laryngomalacia, I was expecting the diagnosis.

In May of last year, I heard a sound that caused me to look twice at the boy sleeping on the sofa. Stridor. Not snoring (stertor), but stridor. My heart thumped a little harder, and I took a video. I posted it to a laryngomalacia support group I belong to, and everyone agreed it sounded like stridor. Here is the video from last year:

 After that afternoon, I rarely heard stridor from Matt. It is very soft and difficult to hear, but I know that sound very well. Matt was growing well and coping well in school, so I decided to tuck it into the back of my mind and ignore it until it presented a real problem.

The real problems began this year in school. Matt can't focus in school. Suggestions of ADD had been tossed around. His teacher, for example, stated that everyone would be lined up at the door, and Matthew would still be at his desk. She would tap him on the shoulder and say, "Hi, buddy, all of our friends are lined up at the door. You need to join them."

Matthew would say, "Oh, why didn't you call my name?"

"I did, buddy, three times!"

And the after-school meltdowns became worse. He couldn't play tennis, because he would be a sobbing heap on the tennis court. He cried when it was time to do anything: to eat, shower, read, or practice piano.

It was time to take action. When Nolan had his ENT appointment in the fall, I mentioned his mouth-breathing, crying, and "ADD" ways to the specialist. She said, "You don't need a referral. How old is he? Seven? Get him in. NOW."

Of course, this is when I preemptively booked the sleep study to save time, since I would have bet money on the fact he had sleep apnea. And the sleep study showed that he had obstructive and central apneas. His sleep architecture was seriously disturbed. No wonder we had an unfocused, crying mess of a boy on our hands every evening.

I had every finger and toe crossed, hoping it was "just" big tonsils and adenoids. When everyone noted that his tonsils were not big, I was pretty sure we were dealing with laryngomalacia.

Despite the cause of the apnea, the symptoms are similar for children who are sleep deprived:

  • Bed-wetting
  • Behavioral problems (tantrums, inability to cope, crying)
  • Exhaustion (falling asleep instantly at night, in the car)
  • "Zoning out" (may be confused with ADD)
  • Snoring may or may not be present
  • Growth failure (Matt did not have this problem)
  • Restless sleep 
For those parents who have children diagnosed with ADD or ADHD, please, please have your child assessed for other disorders that may mimic or cause ADD/ADHD. The American Academy of Pediatrics states that:

  1. 95% of children with obstructive sleep apnea have attentional deficits.
  2. For children with full syndromal ADHD, 20-30% have obstructive sleep apnea.
These statistics are from several research studies (found here) that indicate children with ADD/ADHD should be assessed for sleep apnea and treated if apnea is found, as a significant improvement in symptoms is seen after the child's obstructive apnea is alleviated.


TheSweetOne said...

One last thing to add for parents: Be persistent. If you suspect your child has a sleep disorder, get it checked even if a doctor says they don't.

Our ENT insisted that since Lauren didn't "stop" breathing for 30 seconds or more that she didn't have apnea.

She does.

It took me insisting on a sleep study and then getting a new PEDIATRIC ENT to get it resolved.

Listen to your instincts.

dlefler said...

Yes! Oh, I couldn't agree with this more. So many doctors, even specialists, are unaware of the toll sleep apnea takes on children. The criteria for pediatric sleep apnea are different than for adult sleep apnea. A pediatric ENT is necessary, along with a sleep study to evaluate the type and severity of the sleep disorder.