Giving your patients a good night’s sleep: Diagnosing obstructive sleep apnea
By Scott Knappenberger MD
While obstructive sleep apnea has gained renewed recognition in recent years, it still remains under-diagnosed. In the 1990s, a study of veterans showed that patients who receive continuous positive airway pressure (CPAP) therapy lived seven years longer than their control group. The CPAP system uses a tube to connect an air-producing motor to a mask that fits over the patient’s nose and mouth. After the VA study came out, many physicians began to pay special attention to appropriate diagnosis and treatment options for sleep apnea.
CPAP and other options for adults
CPAP remains the treatment of choice in patients with obstructive sleep apnea, but other options are available for patients who do not like wearing the CPAP mask or refuse therapy with CPAP for other reasons. Otolaryngologists offer patients who do not tolerate CPAP therapy alternatives that improve the patient’s breathing and quality of life. While other treatments are not as effective as CPAP, they are preferable to no treatment at all. Untreated sleep apnea leaves the patient vulnerable to increased risks for multiple comorbid conditions.
Sleep apnea misdiagnosis in children
Like sleep apnea in adults, pediatric sleep apnea is also common and under-diagnosed. While adults with sleep apnea generally present with hypersomnolent symptoms, children sufferers frequently present with symptoms of hyperactivity. Unfortunately, doctors often prescribe these children stimulant medications to help keep them awake and help control their hyperactivity. But this medication does not address the real issue, which is obstructive nighttime sleep apnea.
Misdiagnosing sleep apnea in children can adversely affect their quality of life. In fact, untreated children do more poorly in school – even a letter grade lower – than their peers who receive appropriate therapy.
CPAP naturally will cure children's sleep apnea. But getting a child to wear the CPAP machine is much more difficult than ensuring compliance in an adult. Our role as otolaryngologists is to assess the adenotonsillar region. In most instances, removing the tonsils and adenoids will help open up the pediatric airway and in many cases cure sleep apnea. The quality of life improvement after adenotonsillectomy for snoring and sleep apnea is well documented in the medical literature.
If you suspect your adult or pediatric patient suffers from sleep apnea, we are happy to provide a consultation.
About Dr. Knappenberger
Scott Knappenberger, MD, received his MD from the University of Kansas College of Medicine. He also completed a general surgery internship and residency in otolaryngology at the University of Oklahoma Health Science Center. He joined Kansas City Metropolitan Ear, Nose, and Throat in 2011.