It is recommended that physicians obtain a sleep history in the following children who presents to the primary care:
- symptoms of blocked nose
- recurrent nasal or throat infections
- recurrent ear infections
- parents are concerned about snoring
The following list of question may be useful elicit daytime and night time symptoms associated with disordered breathing:
- ask about night time symptoms
- do they snore?
- do they get a good night's sleep or are they restless?
- do they wake through the night?
- do they struggle with their breathing or stop breathing?
- do they sleep in an unusual position (such as with extended head)?
- do they sweat excessively?
- do they wet the bed?
- ask about daytime symptoms
- do they have any behavioural or concentration problems?
- do they breathe through their mouth?
- are they growing normally?
In primary care the following examination can be carried out in patients with suspected OSA:
- nasal airflow
- can be assessed by holding a cold spatula or tongue depressor under the nose - misting of the cold metal indicates airflow and absence of it may indicate nasopharyngeal obstruction resulting from enlarged adenoids or nasal obstruction, usually caused by rhinitis
- examination of the nasal cavity - for the presence of rhinitis or obstructive polyps
- tonsillar size and presence of any abnormality of the palate - can be done by assessing the mouth and pharynx
- tonsils can be graded according to the percentage of how much the oropharyngeal airway is occupied
- grade 0: Within tonsillar fossa
- grade 1: 0-25% of oropharyngeal airway
- grade 2: 26-50%
- grade 3: 51-75%
- grade 4: > 75%
- neck should be examined for lymphadenopathy
- ears - glue ear may co-exist with adenoid hypertrophy (1)
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