Diagnosis of pediatric obstructive sleep apnea for otolaryngologists

This review describes the current state of the evaluation and diagnosis of pediatric sleep apnea. Sleep apnea in children differs in important ways from sleep apnea in adults and commonly presents with more subtle symptoms. While there can be snoring, noisy breathing, and sleepiness, not all children with sleep apnea snore. Early symptoms can be speech delay, nap refusal, nocturnal enuresis, headaches, and hyperactivity. Children with sleep apnea may have tonsil and/or adenoid hypertrophy, adenoid facies, mouth-breathing, hyponasality, or low-hanging soft palate on exam. While many screening tools exist, definitive diagnosis of sleep apnea in children requires polysomnography. Nocturnal oximetry and home studies are not conclusive but can serve as a screening tool where pediatric polysomnography is not available. In conclusion, pediatric obstructive sleep apnea presents differently than adults and can only be definitively diagnosed with an in-lab polysomnography.