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by Bharatha Malawaraarachchi

Obstructive Sleep Disorders (OSD) in children was a less talked-about issue until a recent study conducted by a research team in the USA made the shocking revelation that children suffering from OSD do not performs well as normal children in their studies.

"For decades OSD did not concern people, but now with new researches like this and medical practitioners getting absorbed in its details, it is becoming a common issue worldwide". Prof. Christian Guilleminault from Stanford University, USA told an annual seminar organised by the Mount Elizabeth Hospital, Singapore last week with special focus on OSD in Children.

Chronic snoring in a child is a sign that should concern parents, paediatrician and educators." Chronic, noisy breathing in a child is abnormal and it is very commonly associated with mouth breathing that is also abnormal," added Prof. Guilleminault who has been researching this subject for well over three decades.

The professor said that the research conducted by Dr. Gosal, Head of Sleep Medicine Unit, Lousiana, USA confirmed that after undergoing a four-year period of treatment, a group of children who were earlier suffering from OSD, improved significantly and performed much better in their studies.

"Children who did not undergo the treatment prescribed by the research team remained under-performing as they were earlier," said Prof. Guilleminault. This is clear example that although children do not complain about OSD, it really affects them, the professor added.

What is OSD

Sleep Disordered Breathing is a concept that has evolved over the past 25 years in children".

Obstructive Sleep Apnea Syndrome was first described, but it became quickly obvious that many children had clinical symptoms related to abnormal breathing during sleep without presenting typical "apneas" at nocturnal polygraphic recording," Prof. Guilleminault said.

According to the Professor, abnormal breathing during sleep leads to many non-specific behavioral difficulties such as hyperactivity, irritability, bed-wetting, sleep terrors and sleep walking, morning headache and also increase in total sleep.

"In worse cases, failure to thrive occurs with abnormal respiratory efforts visible during sleep with nasal flaring and supra-sternal or intercostal retraction," he explained.

More commonly, agitated sleep, sweating during sleep and chronic, noisy breathing are the nocturnal indicators of the problem.

According to Prof. Guilleminault, there are three types of sleep disorders;

(a). OSD where the sleep disorder is due to an obstruction causing a narrowing or blockage of the upper airway(from the nose/throat).

(b). Central sleep disorder where the failure to breathe lies with the brain, nerve or muscles or origin.

(c). Mixed obstructive and central sleep disorder. These are excerpts from an interview Prof. Guilleminault had with the Daily News.

What are the causes of OSD?

Common causes of OSD are; anatomical obstruction such as large tonsils and adenoids or a large and posteriorly-set soft palate, narrow nasal airways, allergic rhinitis, sinusitis etc.

What are the telltale signs of a child who may be suffering from OSD?

(a) Mouth breathing, especially at night (mouth breathing is not normal in children).

(b) Snoring (is also not common in children).

(c) Apnea (when the child actually stops breathing during sleep for periods of more than 10 seconds at a time).

(d) Restless sleep with the child tossing and turning, sitting up or arching the head back while sleeping.

(e) Excessive perspiration during sleep, etc.

At what age do children begin to display signs of OSD?

A child may develop OSD at any time from birth to puberty.

Does it affect a particular race or group of children?

(a). It has been noticed that OSD is more common in the Southern Chinese (including the Cantonese, Hokkiens, Teochews and Hainanese) as it is basically related to the anatomy of the Southern Chinese cheekbone, jaw bone and relatively narrow upper airway.

(b). Children of parents who have the same "adenoid facies" or who have OSD are more likely to have OSD.

What can be done to correct OSD in children? Is surgery the only option?

Surgery is one, but not the sole option to correct OSD. The treatment depends entirely on the cause of the OSD.

Unlike in adults, the majority of OSD in children is due to large tonsils and adenoids which are easy to treat surgically. Removal of enlarged tonsils and adenoids(if these are the causes of the OSD) usually has very dramatic and immediate results.

If the OSD is caused by allergic rhinitis or sinusitis, these are usually treated medically with appropriate medication or nasal steroid sprays.

Obese children with no other upper airway obstructions would benefit greatly from loss of weight.

What can parents do about the home environment to lessen the risk for their children?

If the OSD is caused by allergic rhinitis, sinusitis or obesity, the home environment is very important.

If so, the home should be made as dust-free and smoke-free as possible.

It should also be made as free as possible from tempting fatty and high-calorie snacks and food.

Parents need to give their children counselling and encouragement to lose weight and to teach their children good eating and healthy habits.

What are the effects of OSD on children -both short and long-term? What are the most common effects, and what is the worst that can happen?

Because of the sleep disorder, the sleeping child takes in less airflow and less oxygen. As the heart and brain need a constant supply of oxygen, the body begins to work overtime, trying to get more air and more oxygen.

This leads to a number of problems such as noisy and laboured breathing, mouth breathing or snoring, excessive perspiration, sleep-walking, nightmares, bed-wetting and drooling.

It also causes excessive daytime sleeping, stunted growth, learning impairment or inattentiveness in school and a permanently sunken ribcage.

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