Pediatric Sleep Specialist

• Enlarged tonsils or adenoids
• Chronic allergies or sinusitis
• Enlarged tongue
• Small jaw
• Deviated nasal septum
• Obesity or failure to thrive

Adenotonsillar Hypertrophy

• Primary cause of OSA in children
• Adenoids and/or tonsils grow quicker than the airway
• The first line of treatment is the T&A procedure
• Efficacy: ~59-66%
• Predictors for T&A success: degree of airway obstruction, lower BMI, younger age
• Residual OSA following surgery may require PAP

Consequences of Sleep Disorders in Children

• Physiological: weakened immunity, increased inflammation, increased hunger/higher BMI, diminished development of pre-frontal cortex
• Behavioral: aggression, emotional volatility, withdrawal, hyperactivity
• Academic: poor grades, slower learning, lack of retention, poor attention, and focus

American Academy of Pediatrics Guidelines

• All children/adolescents should be screened for snoring
• Polysomnography should be performed in children/adolescents with snoring and symptoms/signs of OSAS; if polysomnography is not available, then alternative diagnostic tests or referral to a specialist for more extensive evaluation may be considered.
• Adenotonsillectomy is recommended as the first-line treatment of patients with adenotonsillar hypertrophy. High-risk patients should be monitored as inpatients post-operatively.
• Patients should be re-evaluated post-operatively to determine whether further treatment is required. Objective testing should be performed in patients who are high risk or have persistent symptoms/signs of OSAS after therapy.
• Continuous positive airway pressure is recommended as treatment if adenotonsillectomy is not performed or if OSAS persists post-operatively.
• Weight loss is recommended in addition to other therapy in patients who are overweight or obese.
• Intranasal corticosteroids are an option for children with mild OSAS in whom adenotonsillectomy is contraindicated or for mild post-operative OSAS.

Helping your patients sleep better

• Listen for clues about sleep issues such as hyperactivity, lack of focus, behavioral issues and depression
• Write a referral for a consult or sleep test
• CSCC’s board-certified pediatric sleep specialist assist you with your general and more complex pediatric patients as our center is one of two in the DC metro area with a board-certified pediatric sleep specialist dedicated to promoting sleep health in our children and adolescents.
• Let CSCC help you find a Boarded Sleep Medicine Specialist to manage your more complex patients, a lab specializing in pediatric cases or for any questions you may have about sleep