Obstructive Sleep Apnea in Sleepy Pediatric Psychiatry Clinic Patients: Polysomnographic and Clinical Correlates

Study Objectives: To assess the incidence of polysomnographically defined obstructive sleep apnea (OSA) in pediatric psychiatric clinic patients reporting daytime sleepiness on questionnaire, and to identify diagnostic correlates for OSA in this grouping. Design: Prospective and observational. Setting: Outpatient pediatric psychiatry clinic, outpatient sleep medicine clinic, AASM-accredited hospital-based sleep laboratory. Subjects: Children aged 3 to 16 years, reporting daytime sleepiness on questionnaire (N = 74); exclusions: adenotonsillectomy and trisomy 21. Interventions: Parents and children completed a questionnaire designed and validated for identifying pediatric patients with OSA at the pediatric psychiatry clinic. Patients with at least one positive response as to daytime sleepiness (N = 74) were referred for a history and physical by a board-certified sleep medicine physician before in-hospital polysomnography utilizing a routine apnea montage with parent or legal guardian sleeping in room. Results: Mean apnea-hypopnea index (AHI) for this pediatric psychiatry clinic grouping was 5.5. Of these patients, 39.2% had an AHI > 5.0. Mean AHI for patients with attention deficit/hyperactivity disorder (AD/HD) was 7.1; without AD/HD it was 4.5 (p < 0.05). Mean AHI for patients with tonsillar hypertrophy was 6.5 compared with 4.4 for those without tonsillar hypertrophy (p < 0.05). Conclusion: In a clinical grouping of pediatric psychiatry patients reporting daytime sleepiness by questionnaire, polysomnographically defined OSA is common. Both AD/HD as diagnosed using DSM-IV criteria and tonsillar hypertrophy based on clinical exam by a sleep medicine physician are diagnostic correlates for polysomnographically defined OSA in this pediatric psychiatry clinic grouping of patients.

KEYWORDS

AD/HD - OSA - pediatrics - sleepiness - tonsillar hypertrophy

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