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Children's Sleep Disorders Can Go Undiagnosed

The school year has just begun, but it's time for parents to do their homework. Lewis J. Kass, MD , a pediatric pulmonologist and owner and founder of Westchester Pediatric Pulmonology and Sleep Medicine in Mount Kisco, says parents' assignments can come in the form of noting their children's sleep patterns.

Too often, he says, parents learn from a teacher that their child is unfocused, inattentive and/or hyperactive. "Research began trickling in the late 1990s that demonstrated a clear link between obstructive sleep apnea (OSA) and neurocognitive deficits," says Dr. Kass. In fact, he says, research shows that 15 to 65 percent of children with Attention Deficit Hyperactivity Disorder (ADHD) have underlying sleep disorders.

According to Dr. Kass, sleep disorders can affect children of all ages, although symptoms vary widely depending on their ages. Toddlers, for example, might manifest sleeping issues with frequent tantrums and premature elimination of their naps, and they can also become irritable during the day. Kindergarten-aged children might show symptoms in the classroom in the form of sleepiness, irritability or hyperactivity, and they could begin having behavioral issues, such as acting out, says Dr. Kass. As children approach adolescence, sleep deprivation can present itself with, he says, with poor school grades, hyperactivity and mood swings.

If they're at the point of considering medication for their children, Dr. Kass asks parents: "Why not first spend one night in a sleep lab to rule out a treatable sleep disorder?" Doing so begins with a comprehensive history and physical exam. If he recommends a sleep study for a child, Dr. Kass will tailor the overnight in the hospital's sleep center – which is more hotel than hospital – with his/her parent. The study, says Dr. Kass, is painless and non-invasive.

A week after, Dr. Kass meets with the parents to discuss findings and next steps. Among the most common causes of sleep problems in children, he says, are obstructive sleep apnea, asthma, restless legs syndrome, gastroesophageal reflux or narcolepsy. But, he says, "The great news is that anything identified can be treated."

Sleep apnea can be treated by removal of the tonsils and adenoids or with mild air pressure to keep airways opened by using CPAP (Continuous Positive Airway Pressure) , he says. And most of the other sleep disorder diagnoses are treated with medicine or cognitive behavioral therapy.

Dr. Kass recommends a sleep evaluation for children who have restless, sweaty sleep, nighttime awakenings, daytime sleepiness or irritability, snoring or leg kicks. Additionally, he says, for children "if a diagnosis of ADHD has been considered along with persistent bedwetting, poor school grades, difficult to control asthma, insulin resistance, obesity or chronic headaches."

Recognizing your child's sleep patterns might take a little homework, but doing so could help you all rest a little bit easier.

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