Research into pediatric sleep disorders is shedding light on the clinical and behavioral manifestations of disrupted sleep in children. Some of these manifestations are typical across all age groups, particularly in those with sleep-disordered breathing, and include snoring, restless sleep, morning headaches, difficulty waking and diminished concentration.

The presentation of pediatric obstructive sleep apneas syndrome (POSAS) differs with age. Younger children generally in the age range of 2 to 9 often demonstrate hyperactivity, impaired attention and behavior problems. The child often becomes very combative before sleep. Loud snoring is common, but other abnormal respiratory noises are frequently present, such as grunting and stridor. Parents commonly report the use of accessory respiratory muscles and suprasternal/intercostal retractions. Frequent body movements are also typical, leading the parent to report the child as a restless sleeper. Enuresis is frequently present.

However, one of the major symptoms of disrupted sleep Æ hypersomnolence Æ is atypical in children. They are more likely to exhibit hyperactivity during the day. In fact, a significant number of parents of children with attention deficit hyperactivity disorder report that their children also have problems consistent with a sleep-disordered breathing diagnosis. These overlapping symptoms include nighttime enuresis, weight gain or obesity, nightmares and bedtime resistance. Hypersomnolence as typically expected in adult obstructive sleep apnea may or may not be elicited during a history, which is related in part to the childÍs lack of insight into and appreciation of the effects of sleep quality. Symptoms of hypersomolence include difficulty arising from bed, daytime naps, irritability and impaired concentration, often manifested as deteriorating academic performance. The physician managing POSAS must appreciate that adult sleep study scoring and diagnostic criteria for OSA do not apply to the pediatric sleep study.

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