Dr Susan Millard on Assessment, Treatment Process of Pediatric OSA

There are several signs characteristic of obstructive sleep apnea (OSA) in children and adolescents, but a sleep study interpreted according to pediatric standards is the only way to properly diagnose sleep apnea, restless leg syndrome, or primary snoring in these populations, said Susan Millard, MD, FAAP, pediatric pulmonologist at Helen DeVos Children’s Hospital and associate professor of pediatrics at Michigan State University.

Transcript

AJMC^®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences’ Medical World News, The American Journal of Managed Care^® is pleased to welcome Dr Susan Millard, a pediatrician and coauthor of a list of 5 recommendations that Physicians and Patients Should Question on Pediatric Pulmonology and Sleep in Children as part of the Choosing Wisely campaign.

For parents observing signs of sleep issues in their children characteristic of a more severe disorder such as childhood OSA, what is the optimal way in which to seek treatment and what is the assessment and treatment process like?

Millard: So, usually people start at the family practice or pediatricians’ office with a concern. We do get referrals from dentists also for small interferences, which is awesome–or orthodontists. The sleep study documented OSA is about 2% to 5% of kids. Peak incidence is between age 2 and age 8, but some parents notice restless sleep with sleep apnea, they can also have periodic limb movement disorder that causes them to be sleepy during the day and restless in bed.

Usually toddlers with sleep apnea are actually busier during the day, they're not sleepy compared to an adolescent or adult if they have sleep apnea. They have excessive daytime somnolence. Children can also present with being thirsty, waking up more because their mouth breathing–they're dry and they want to go get a drink of water. So, that can be a symptom.

Patients can also–children take a while to get potty trained, but if you're a 10-year-old and don't have a family history of problems with bedwetting, then that can be a sign of sleep apnea. The hard part though, Matthew, is that children can have a lot of symptoms, but a sleep study is the only screening mechanism really to determine whether they have sleep apnea or restless leg syndrome or primary snoring. And what primary snoring is, is that they make a noise, but don't have the full sleep apnea.

There is some controversy about primary snoring, whether it's significant that they might also benefit from an adenotonsillectomy, but that's really based on what the child's situation is, their health, their development, and what the ear, nose, and throat doctor will discuss with them.

AJMC^®: Lastly, do you have any other concluding thoughts?

Millard: Well, I think that the initiative is very important. There's actually an app now for Choosing Wisely that you can download, and it's for patients and providers, where you can actually look through all the different organizations and their recommendations.

The other thing about the American Academy of Pediatrics is we worked on our Choosing Wisely points for about 5 years. We went with a group at a meeting, American College of Chest Physicians meeting, and we broke out in focus groups to kind of discuss what people's favorite topics would be. Then those were sifted down, we got documentation and verification about why it was important. And then it was actually voted on first by our section at the American Academy of Pediatrics and then on higher up. So, it went through many levels of evaluation.

So, I think that helps people understand that it's not just something that's quickly done or a knee jerk situation. And then they are revised also, so there can be updates.

AJMC^®: To learn more, visit our website at ajmc.com. I’m Matthew Gavidia, thanks for joining us!