8. Investigation and treatment of upper-airway obstruction: childhood sleep disorders I.

Always take a history of snoring and sleep disturbance when reviewing children in primary care, as there is evidence that episodes of hypoxia and arousal during sleep may result in deficits in memory, attention and behaviour, in addition to the well known sequelae of growth failure, developmental delay and cor pulmonale. Check for changes in behaviour affecting school progress. To investigate for possible obstructive sleep apnoea syndrome (OSAS), clinical examination, lateral neck x-ray (adenoidal hypertrophy) and overnight oximetry (desaturation episodes) are useful screening tests, but oximetry is best used in conjunction with polysomnography. A negative oximetry test does not exclude OSAS. Polysomnography is the best method for detecting and assessing the severity of OSAS in children, and is especially helpful for prioritising treatment and evaluating the risk of perioperative complications of adenotonsillectomy. Adenotonsillectomy is thought to "cure" (ie, symptoms disappear and overnight respiratory parameters are corrected) in about 80% of children with OSAS. The remaining 20% need ongoing evaluation and treatment. Further research is needed to determine the "true" prevalence of OSAS; what degrees of severity of upper-airway obstruction lead to morbidity requiring treatment; and whether the deficits in neurocognitive function associated with sleep-disordered breathing are fully correctable.