Pediatric sleep disorders

Sleep disorders may be behind a child’s lack of concentration

 
 
 <span class="cutline_leadin">‘COMPLEX ISSUE’:</span> Dr. Juan Martinez, medical director of the Joe DiMaggio Children’s Hospital Division of Pediatric Pulmonology, specializes in kids’ sleep disorders.
‘COMPLEX ISSUE’: Dr. Juan Martinez, medical director of the Joe DiMaggio Children’s Hospital Division of Pediatric Pulmonology, specializes in kids’ sleep disorders.
Hector Gabino / El Nuevo Herald

jsalo@MiamiHerald.com

With any malady, the symptoms that arise can lead medical professionals down paths to a range of unsound conclusions. Pediatric sleep disorders are no exception, and according to local experts, children who suffer from them are often misdiagnosed.

Symptoms of sleep disorders are indistinguishable from a number of more prevalent health concerns that parents and health professionals alike are quicker to consider.

One common misdiagnosis is attention deficit hyperactivity disorder (ADHD), which has been diagnosed in 11 percent of children nationwide, according to the Centers for Disease Control and Prevention. Its hallmark symptoms — lack of concentration, impulsiveness and hyperactivity — can also be the consequence of a pediatric sleeping disorder.

Dr. Juan C. Martinez, who specializes in sleep disorders as the medical director of the Joe DiMaggio Children’s Hospital Division of Pediatric Pulmonology, has seen a number of patients who came to him improperly treated for these symptoms.

“It is a very complex issue because the symptoms of obstructive sleep are often confused with ADHD,” Martinez said. “The teasing out of which disorder it is is not as easy as it sounds.”

Another local specialist, Dr. Michael Duchowny, who is a pediatric neurologist at Miami Children’s Hospital, advises any parents that have children treated for ADHD to consider consulting a sleep specialist.

“Children who are chronically sleep deprived may be prone to problems with attention behavior, learning and mood,” Duchowny said. “It’s important that any child who has been diagnosed with ADD, be evaluated to exclude the possibility of nocturnal sleep apnea.”

But even when children with sleeping disorders are brought to specialists, they still sometimes leave undiagnosed. Some sleep specialists are not trained to recognize the divergent symptoms between children and adults suffering from sleep apnea, a disorder in which breathing is interrupted during sleep.

“These are studies that should really be done in a pediatric facility,” Martinez said. “When they end up studying at adult studies, they do not understand the staging and scoring of pediatric sleep disorders. Some are mis-scored using adult criteria.”

Martinez also attributes the lack of attention to pediatric sleep disorders to misdiagnosis.

“I think that a lot of media attention given to ADHD over the last 20 years,” he said. “It has been in the press more. Some of the information on pediatric sleep medicine is relatively new … Sleep medicine was not even part of most medical school curricula until recently.”

Sleep apnea is likely responsible or contributing to the child’s daily functioning if they also snore frequently or gasp for air throughout the night, Martinez said.

“I am talking about kids who snore relentlessly at night and it is day in and day out,” Dr. Martinez said.

And ADHD is not the only misdiagnosis drawn from the symptoms exhibited by sleep disorders. One patient at Miami Children’s Hospital Sleep Disorder Center went through a number of diagnoses before her condition came to light.

In broad daylight, in the middle of conversation, and even at the dinner table, Anisa Bryant’s daughter, Ashlyn, 9, would simply fall asleep.

“She wasn't able to stay awake in daycare. She would be playing with children, and she would just fall asleep,” Bryan said. “One day at summer camp, it was very hot outside, and she just fell asleep on the ground.”

Before the playground incident, Bryant had been told her daughter had mononucleosis. Weeks later, her sleeping habits were still abnormal. At night, she wouldn’t sleep more than two consecutive hours.

Bryant said her daughter’s teachers complained about her behavior, and her grades were poor.

After consulting with a sleep specialist, Ashlyn was diagnosed with sleep apnea due to enlarged tonsils and underwent surgery. Further testing then also revealed she was suffering from severe narcolepsy.

Duchowny said parents can closely examine their child’s sleeping patterns to rule out a sleeping disorder. Children should get a minimum of eight to 10 hours of undisturbed sleep, but he says it will depend on the child’s activity levels and specific needs.

After Bryant’s daughter started to receive treatment for her condition, she began to have a more normal sleeping routine.

“She is more alert, more talkative. She has gotten a lot better at focusing,” Bryant said. “She is very sharp and aware.”

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