The Sleepy Child Conundrum: What to consider when SDB is ruled out

In a modern society that is constantly “on,” with 24-hour news channels, Internet connection, cell phones, video games, and a rapid pace of life unequaled in previous generations, sleep deprivation and sleep disorders are not only a risk—they are a given. Inadequate sleep may even be the next big public health outcry in the U.S., according to Suzan Garetz, MD, of the Department of Otolaryngology-Head and Neck Surgery at the University of Michigan Health System in Ann Arbor, Mich.

In such a stimulated, saturated society, children and adolescents are not exempt; indeed, they can suffer the most, particularly if their symptoms of daytime sleepiness are not correctly diagnosed and treated. Otolaryngologists, who often see children and adolescents with daytime sleepiness in whom sleep disordered breathing (SDB) is suspected, need to consider other reasons for daytime sleepiness in order to accurately and adequately treat the whole child.

Although the most common reason for sleepiness in children and adolescents is insufficient sleep caused by poor sleep hygiene, other conditions may actually be to blame and could confer substantial harm if not correctly identified.

Know Thy Sleepiness

“Often otolaryngologists evaluating sleep disturbances in children and teens will focus on sleep apnea and not delve into other possible sleep problems,” Dr. Garetz said. “As otolaryngologists, we also need to be aware of other conditions causing sleep disturbances in that population.”

Among the most common sleep problems that occur, either alone or in conjunction with SDB, are poor sleep hygiene and circadian rhythm disorder (or delayed phase sleep). Less common are narcolepsy and restless leg syndrome, both of which can carry a high morbidity if not correctly diagnosed.

According to David Gozal, MD, a pediatric sleep specialist and physician-in-chief at Comer Children’s Hospital at the University of Chicago Medical Center in Chicago, the easiest way to approach the challenging task of determining the cause of daytime sleepiness in children is to recognize that sleep disorders basically fall into three categories: 1) children who get sufficient sleep but still have daytime sleepiness (e.g., narcolepsy); 2) children who get insufficient sleep and are sleepy (e.g., poor sleep hygiene, circadian rhythm disorder); and 3) children who are sleepy because of disruptive sleep (e.g., SDB, restless leg syndrome).

“We try to look for clues that will give us some answer to whether we’re dealing with one of these three categories and then we look in more detail into which category it is,” Dr. Gozal said.