We team members need to be educated on sleep and how to communicate and educate patients to make decisions that are best for them. When it comes to kids, not only should we be aware of sleep breathing disorders but we need to help educate parents on what to look for, what to be concerned with, and how to approach the medical community.
When a child is diagnosed with Obstructive Sleep Apnea (OSA) the Apnea Hypopnea Index (AHI) is 1 or more events for the whole night, not per hour. You can see how much more sensitive this is compared to adult OSA diagnosis of 5 events per hour or less as normal! This means if a parent witnesses a child struggle to breathe at night, that child only needs to exhibit one episode of total airway cessation for 10 seconds or longer. Parents are the best witnesses and whistle-blowers to have their child observed and evaluated for OSA. Let’s look at ways to educate parents on clinical signs and symptoms, risk factors and how to bring this up to physicians.
“He’s just tired…irritable…distant…and uninterested. However, he never used to be like that.” These are phrases I hear from parents all the time and when the topic of sleep breathing and quality come up most are fascinated with the connection. It’s simple. If we don’t breathe well during sleep, our sleep cycles can become interrupted causing fragmented sleep which can have a huge negative impact on our overall physical health and mental wellness. When this happens with children the ramifications are massively negative to every aspect of growth and development.
In a dental office we see signs and symptoms of obstructed airways in both adults and children all day everyday. For adults it may be difficult to point out some of these signs; you may see dark circles under the eyes, but no one likes to hear they look tired. However, in children the “allergic shiner” should be a topic of discussion with parents as it can be a dead giveaway that the blood is pooling under the eyes as a result of nasal and sinus congestion. To talk to parents about this sign and ask questions about symptoms is a great way to present the value of observation. Like any sign, it is not a diagnosis so the more we can observe the better we can inform physicians when the time comes for an evaluation and diagnosis.
Here is a list of the most common signs and symptoms of obstructed airways in children along with risk factors to be aware of:
- Lingual tongue tie
- Speech impairment
- No spaces between primary teeth
- Retrognathic jaw (skeletal and dental)
- Lingually inclined teeth
- High palatal vault
- Reports of clenching or grinding
- Bed wedding
- Night terrors
- Restless sleep
- Allergies (nasal congestion)
- Mouth breathing (check pillow)
- Allergic shiner (dark circles under the eyes)
- Hyperactivity (ADD/ADHD)
- Loss of interest in learning
- Mood swings
Now that we know what to look for, how to do have conversations with parents? We do this as we do with adults – simply ask: Has your child’s sleep ever been evaluated? Explain that an obstruction in sleep breathing can cause all of these signs and symptoms. Most parents have no idea bedwetting at age 10 could be linked to sleep breathing. Most have no idea that when a child is lingually tongue-tied it restricts the child from using the tip of his/her tongue to expand his/her maxilla, which happens to be the base of the sinus cavity. Most have no clue mouth breathing could be restricting the child’s growth and mental development. Of course once parents are interested in learning more it is best to direct them to a physician and orchestrate a sleep evaluation.
Direct parents to a physician. Easier said than done in some cases. My own godson Charlie has a sleep breathing issue and his mother became aware of it and had her pediatrician evaluate him. The pediatrician said “No, he is fine – no evaluation needed.” She immediately looked for another opinion. The second physician listened to her concerns and evaluated his sleep and breathing. As the exam occurred it became very apparent Charlie was not able to breathe through his nose and it was suspected that he hadn’t been able to for several years. He is currently being treated and his parents are grateful for the second opinion. In my experience, it is best for parents to become educated and search for medical professionals who understand the impact of an obstructed airway. Dentists and teams are working hard to develop relationships with physicians and it would be a great start to find like minded physicians that are proactive with sleep breathing evaluations. Until then, educating parents is key and offering resources like the Foundation of Airway Health (FAH) so they can learn more. Finding Connor Deegan is a great video FAH posted on YouTube (https://www.youtube.com/watch?v=Sk5qsmRyVcE) that has helped parents become more aware of sleep breathing issues in children. Our dental profession can work directly with physicians to help identify children at risk. However, a concerned persistent parent should get the job done and it’s best to support and educate as best we can.
Editor’s Note: This Sleep Team Column will be dedicated to the team and provide practical tips and resourceful information. Let us know your specific issues by email to: SteveC@MedMarkAZ.com, while we can’t respond to every individual. Your feedback will help us create the most useful Sleep Team Column we can!