Question:

Dear Doctor,

I have a 3-year-old son that I am very worried about. He has been having more trouble paying attention at the level of his preschool friends. He sleeps poorly at night and snores. His breathing seems irregular. He often seems tired during the day. He does not seem to be growing as much as he should recently.

I have talked with his pediatrician and she suggested that he might have ADD. I am reluctant to have him take medication. My sister in law is a preschool teacher, she told me that one of the children that she cares for had similar problems, and they did a "sleep apnea study" to see if he was breathing poorly during the night. She said that the test was abnormal and that he had his tonsils and adenoids out and his behavior and growth improved significantly.

Could this be what is wrong with my son? If so, what should I do about it?

Thank you for considering this.

Concerned mom

Dear Concerned mom,

Yes, your child could have sleep apnea and it could explain all of his symptoms. The best way to find out is to have your pediatrician refer you to a sleep study clinic. They are often found at major university hospitals such as Stanford. in Palo Alto, California.

These clinics specialize in sleep studies that are called polysomnograms. This is a study where your child would spend the night at the center and have multiple body functions monitored during his sleep. These include brain waves (EEG), eye movements (indicating stage of sleep) and a monitor on a muscle that is an indicator of deep (REM or rapid eye movement) sleep. Frequently other things are monitored such as blood oxygen, breathing depth and frequency, sound recording for snoring and heart electrical activity Doing this during the night is better than during naptime because you are more likely to get a better test during a longer period of sleep. If the test is positive, showing that your child has decreased oxygen in his blood during sleep, then the doctors will to talk with you about treatment options.

There are, however, other possible causes for your child's difficulties. ADHD could be one, another could be that your child is anxious or depressed. (Yes, children this age can be depressed). If there are no obvious reasons for worry or depression, then a sleep study is probably a good place to start.

The Academy of Pediatrics has published a "position statement on sleep apnea syndrome". As in many of the medical specialties, pediatricians have decided to establish statements on a variety of treatment issues. These are created by a large team of experts, in this case neurologists and pulmonary medication pediatricians, as well as others. They review all the available research and develop guidelines for the diagnosis and treatment. The following link is a summary of the results for sleep apnea syndrome.

http://aappolicy.aappublications.org/cgi/gca?gca=pediatrics%3B109%2F4%2Fe69&sendit=Get+Checked+Abstract%28s%29

As you can see, Obstructive Sleep Apnea has been impressively well studied. I have spoken with professionals in the field and found them very sensitive to concerns expressed by some pediatricians who have thought that this syndrome really does not exist.

I would be interested in hearing your child's ultimate diagnosis and treatment.

Kay S. Browne MD