Childhood Sleep Apnea Differential Diagnoses
- Author: Mary E Cataletto, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP more...
Obstructive sleep apnea (OSA) must be differentiated from simple snoring, which is a vibratory inspiratory noise that is usually not accompanied by oxygen desaturation, hypercapnia, or sleep disruption. Overnight polysomnography can be performed to differentiate pronounced snoring from true obstructive sleep apnea in the pediatric age group.
Go to Upper Airway Evaluation in Snoring and Obstructive Sleep Apnea for complete information on this topic.
Daytime somnolence is a common complaint among individuals with obstructive sleep apnea. For teens and adults, this may be the presenting concern that brings them to medical attention. However, keep in mind that not all children with excessive daytime somnolence have obstructive sleep apnea. Sleepiness during the day may be due to numerous factors in addition to sleep apnea. Many children are sleepy during the day simply because their parents do not have a clear idea as to how much sleep a child actually requires.
Chaotic sleep schedules with inconsistent bedtimes and rise times and with limited time allowed for sleep are major causes of daytime sleepiness and lassitude. Any evaluation for suspected sleep apnea must include a careful history with inquiries about sleep times, bedtime routines, and a description of the sleeping environment. Parents should be asked to complete a sleep diary for 1-2 weeks to evaluate whether a child is sleeping enough.
Narcolepsy is a disease characterized by irresistible sleeping attacks that occur intermittently throughout the day. It is included in the differential diagnosis of excessive daytime sleepiness. Patients with narcolepsy are tired throughout the day; thus, the disorder can be confused with obstructive sleep apnea syndrome. A history of episodic sleep-onset paralysis, hypnagogic (sleep-onset) hallucinations, or daytime memory lapses with automatic behaviors may help differentiate between narcolepsy and obstructive sleep apnea. Sleep paralysis is a frightening experience that lasts from a few seconds to several minutes, during which an individual can breathe and move the eyes but otherwise cannot speak or move.
Hypnagogic hallucinations are vivid lifelike dreams that occur just as one begins to fall asleep. These hallucinations often involve an awareness of another person or an animal in the room, bright colors, or unusual shapes. Often, other senses are involved during the experience, including touch, smell, and hearing. Older patients with narcolepsy may experience cataplexy, or the sudden brief loss of muscular tone without loss of consciousness. Multiple sleep latency testing (MSLT) following overnight polysomnography is necessary to confirm a diagnosis of narcolepsy and differentiate this from obstructive sleep apnea.
Nocturnal gastroesophageal reflux
Nocturnal gastroesophageal reflux may result in nocturnal restlessness, choking episodes during sleep, frequent awakenings, and labored breathing that resemble symptoms of obstructive sleep apnea syndrome.
Periodic limb movement disorder, nocturnal seizures, rhythmic movement disorder, and various parasomnias can be differentiated from obstructive sleep apnea on the basis of polysomnography.
Verhulst SL, Van Gaal L, De Backer W, Desager K. The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev. 2008 Oct. 12(5):339-46. [Medline].
Isono S, Shimada A, Utsugi M, Konno A, Nishino T. Comparison of static mechanical properties of the passive pharynx between normal children and children with sleep-disordered breathing. Am J Respir Crit Care Med. 1998 Apr. 157(4 Pt 1):1204-12. [Medline].
Marcus CL, Lutz J, Carroll JL, Bamford O. Arousal and ventilatory responses during sleep in children with obstructive sleep apnea. J Appl Physiol. 1998 Jun. 84(6):1926-36. [Medline].
Moon RY, Horne RS, Hauck FR. Sudden infant death syndrome. Lancet. 2007 Nov 3. 370(9598):1578-87. [Medline].
Beebe DW, Gozal D. Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res. 2002 Mar. 11(1):1-16. [Medline].
Tauman R, Gulliver TE, Krishna J, Montgomery-Downs HE, O'Brien LM, Ivanenko A, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006 Dec. 149(6):803-8. [Medline].
Gozal D, Kheirandish-Gozal L. Obesity and excessive daytime sleepiness in prepubertal children with obstructive sleep apnea. Pediatrics. 2009 Jan. 123(1):13-8. [Medline].
Guilleminault C, Huang YS, Glamann C, Li K, Chan A. Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg. 2007 Feb. 136(2):169-75. [Medline].
Bonnet MH. Effect of sleep disruption on sleep, performance, and mood. Sleep. 1985. 8(1):11-9. [Medline].
Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998 Sep. 102(3 Pt 1):616-20. [Medline].
Montgomery-Downs HE, Crabtree VM, Gozal D. Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea. Eur Respir J. 2005 Feb. 25(2):336-42. [Medline].
Bixler EO, Vgontzas AN, Lin HM, Liao D, Calhoun S, Fedok F, et al. Blood pressure associated with sleep-disordered breathing in a population sample of children. Hypertension. 2008 Nov. 52(5):841-6. [Medline].
Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr. 1994 Oct. 125(4):556-62. [Medline].
Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A. The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. J Pediatr. 1999 Jul. 135(1):76-80. [Medline].
Tal A, Leiberman A, Margulis G, Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol. 1988. 4(3):139-43. [Medline].
Li AM, Chan MH, Yin J, So HK, Ng SK, Chan IH, et al. C-reactive protein in children with obstructive sleep apnea and the effects of treatment. Pediatr Pulmonol. 2008 Jan. 43(1):34-40. [Medline].
Barbé, Pericás J, Muñoz A, Findley L, Antó JM, Agustí AG. Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. Am J Respir Crit Care Med. 1998 Jul. 158(1):18-22. [Medline].
Marcus CL, Radcliffe J, Konstantinopoulou S, Beck SE, Cornaglia MA, Traylor J, et al. Effects of positive airway pressure therapy on neurobehavioral outcomes in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2012 May 1. 185(9):998-1003. [Medline].
Marcus CL. Nasal steroids as treatment for obstructive sleep apnea: Don't throw away the scalpel yet. J Pediatr. 2001 Jun. 138(6):795-7. [Medline].
Mukhatiyar P, Nandalike K, Cohen HW, Sin S, Gangar M, Bent JP, et al. Intracapsular and Extracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg. 2016 Jan 1. 142 (1):25-31. [Medline].
Chervin RD, Ellenberg SS, Hou X, Marcus CL, Garetz SL, Katz ES, et al. Prognosis for Spontaneous Resolution of Obstructive Sleep Apnea in Children. Chest. 2015 Mar 26. [Medline].
Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics. 2006 Jan. 117(1):e61-6. [Medline].
Perfect MM, Archbold K, Goodwin JL, Levine-Donnerstein D, Quan SF. Risk of behavioral and adaptive functioning difficulties in youth with previous and current sleep disordered breathing. Sleep. 2013 Apr 1. 36(4):517-25. [Medline]. [Full Text].