A good night sleep is very important for good health but some children are divested of sleep due to Sleep Disordered Breathing (SDB).SDB is defined as clinical spectrum of repetitive episodes of complete or partial obstruction of the airway during sleep. This disorder consists of OBSTRUCTIVE SLEEP APNEA (OSA)characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns. Disruptive sleep pattern may affect the child’s general and social well being. .Early diagnosis and treatment interventions are important to improve child’s long-term cognitive development, social interaction, academic achievement, cardiovascular health and overall wellbeing.
Obstructive sleep apnea syndrome (OSAS) first was reported in children in Guilleminault (1976).OSA in children typically appears between the ages of 2 and 7 years.OSA has a bimodal age of occurrence with the first peak coinciding with the developmental peak of adenotonsillar hyperplasia (2-5 years). The second peak appears in middle to late adolescence.
Risk factors for development of OSA in children include a family history of snoring or OSA, physical abnormalities, cerebral palsy, muscular dystrophy, Down’s syndrome, sickle-cell disease, mouth breathing and any condition that may lead to a narrowing of the upper airway.
An important general risk factor for OSA is obesity.Increased upper airway resistance during sleep in children with OSA is most likely due to a combination of soft tissue hypertrophy, craniofacial dysmorphology, neuromuscular weakness or obesity.
The most common cause of pediatric OSA is adenotonsillar hypertrophy

Telling Signs of OSA among children include snoring, pauses in breathing while asleep, restless sleep, bizarre sleeping positions , paradoxical chest movements, cyanosis, bedwetting, hyperactivity, stunted growth and disruptive behaviour in school Snoring, which does not alter the sleep architecture, is considered a relatively benign and harmless condition In contrast, OSA can result in severe complications if left untreated. Such complications may include : affects CVS system causing increased Blood Pressure ; DEPRESSION – most common mood disorder; Attention Deficit Hyperactivity Disorder in future ; CO2 accumulation coupled with Acidosis may leading to Impaired Responses To Growth Hormone and Increased respiratory efforts causes depletion of calorie bank and lead Failure To Thrive.

The American Academy of Pediatrics (AAP) has established clinical guidelines for the diagnosis of OSA .

1. Compulsory screening is must in all children with snoring.
2. Referral to a specialist for high complex high-risk patients.
3. Elective evaluation for patients with cardiorespiratory failure.
4. Diagnostic evaluation is useful in discriminating primary snoring and OSA, with the gold standard being polysomnography.
5. The first line of treatment remains adenotonsillectomy for most children, and continuous positive airway pressure is an option for those who are not candidates for surgery or who do not respond to surgery
6. High-risk patients should be monitored as inpatients postoperatively.
7. All patients should undergo clinical reevaluation postoperatively to determine whether additional treatment is required.

The gold standard for diagnosis of OSA is overnight polysomnographic testing with measurement of respiratory variables . This testing procedure as a whole is known as POLYSOMNOGRAPHY , IN LAB SLEEP STUDY. Technician conducting the test are Registered Polysomnographic Technologist (RPT).

Pediatric dentist can play a role of ‘Gatekeepers’ to diagnose enlarged adenoids and tonsils or any craniofacial dysmorphology and could make a difference in these cases.