Sleep matters. At no time in medical history has this been clearer. During the critical formative years, making sure that children get the restful, quality sleep they need is vital.
For children, the symptoms of sleep-disordered breathing — including OSA (Obstructive Sleep Apnea) and snoring — have been shown to negatively impact behavior and the ability to pay attention. Much was learned about this in the Avon Longitudinal Study of Parents and Children that examined the impact of mouth breathing, apnea and snoring on behavior in a group of more than 11,000 subjects spanning from infancy to age 7. This study uncovered a litany of connections between sleep-disordered breathing and heightened risk of attention deficit hyperactivity disorder, tendencies toward aggression, anxiety disorders, and behavior problems. The authors found that sleep-disordered breathing symptoms occurring before age 5 were associated with a 40% greater chance of special education needs by age 8.
Because their brains are still developing, screening for sleep disorders is paramount for children, as any hindrance in adequate oxygenation, and therefore parasympathetic sleep, can have an immediate and lasting effect.
Physically, evidence of sleep-disordered breathing presents in myriad forms, such as a long and narrow face, habitual open-mouth posture or venous pooling (dark circles under the eyes). Behavioral symptoms might include chronic mouth breathing, hyperactivity, snoring or bedwetting.
The seven common signs of sleep-disordered breathing include:
- High/narrow palatal vault
- Mouth breathing
- Clenching and grinding or tooth wear
- Enlarged tonsils and adenoids
- Allergic rhinitis or prevalence of allergy symptom
- Tongue tie and/or lip tie
- Maxillary and mandibular deficiency
If a clinician detects any of these symptoms, the next step would be to get the parents/caregivers involved. Key questions might include:
- Does the child snore, or make any noise while sleeping?
- Does he or she stop breathing for short periods during sleep?
- How rested does the child seem upon waking?
- Has he or she experienced behavior issues at home or school?
Assessing a child’s sleep habits can also help oral health professionals in treatment planning and educational efforts. Toward this end, the parent/caregiver should be asked not just how long a child sleeps, but also how well the child sleeps. Many adults will report their children sleep the whole night, which is usually a sign of adequate sleep quantity, but if the child shows signs of sleep-disordered breathing, the adult should be suspicious of possible poor sleep quality. Asking the parent/caregiver to spend 20 minutes watching the child sleep may help answer the first two question. How the clinician proceeds will vary based on relationships with other qualified health professionals, which, as previously noted, could include referrals to a pediatrician, ENT specialist, sleep physician, orthodontist, pediatric dentist or oral myofunctional therapist experienced in treating malocclusion that might be comorbid with sleep-disordered breathing and airway restriction. Utilizing a team approach will help optimize treatment for each patient.