Introduction to The London Pediatric Sleep Clinic
The clinic started in the fall of 2017 for the purpose of providing access to a qualified sleep
physician and diagnostic testing. The clinic also hopes to increase the awareness of sleep
apnea in children as well as the complications associated with sleep apnea. Pediatric sleep
apnea is a relatively new field, with testing beginning in the 1980s and significant research
coming only within the last 10 years. Most physicians do not have any training in the field of
sleep apnea.
Sleep disordered breathing includes a wide range of problems, including insomnia, narcolepsy,
parasomnias, circadian rhythm problems as well as obstructive sleep apnea. The most urgent
local need is the identification of those with obstructive sleep apnea (OSA) and the recognition
of OSA complications in children who go untreated. This clinic will be available for all sleep
disorder concerns, but focus on OSA.
What is OSA?
OSA is when the back of the patient’s throat (upper airway) closes while the child is trying to
breathe in and either less air (hypopnea) or no air (apnea) occurs. When hypopnea or apnea
occurs, the body will react to overcome the obstructed airwave, causing the child to briefly
awaken. This awakening, which is rarely recalled, can happen many times a night and greatly
reduce the child’s quality of sleep. This lack of restorative sleep can result in difficulties with
getting up in morning, concentrating at school, daytime tiredness, changes in behaviour, and
changes in academic performance, as well as many other problems.
Some behavioural symptoms associated with childhood OSA can resemble and be misidentified
as ADHD. Subsequently, treatment of OSA can resolve these symptoms.
It is believed that children with undiagnosed OSA are more likely to develop anxiety and
depression during their adolescence, as well as affecting their academics throughout. In adults,
and perhaps children, OSA is known to result in high blood pressure, coronary heart disease
and metabolic syndromes like diabetes, among other maladies.
OSA in children often presents itself with excessive snoring, and there are several easy
screening tests to suggest it is sleep apnea. These screening tests can be found in your
doctor’s office, online, or downloaded from this website.
However, screening tests do not offer a comprehensive analysis, and they are what the name
implies; simply a screening to determine who does, or does not, have OSA. Unfortunately,
neither the screening test nor an extensive review of the patient’s history by a qualified sleep
analyst, is as accurate as laboratory testing. For example, 15% of children with significant
apnea do not snore, and therefore would not be identified without laboratory testing. Even
formal sleep testing must be interpreted in the light of the patient’s history and physical
examination.
In children, the most common cause of significant sleep apnea are enlarged tonsils and
adenoids. Other complications of enlarged adenoids are problems hearing, frequent ear
infections, and chronic upper airway infections, which can need surgery to resolve.
Sometimes these symptoms are not present and if the patient has suggestive symptoms of poor
sleep, it then becomes important to confirm sleep apnea. Sleep apnea can only be confirmed by
a sleep study.
Sleep Study Access
The main problem with diagnosing sleep apnea is the lack of access to sleep studies. Currently,
some adult sleep labs will accept children over the age of 12 years. You can speak to your
physician about that availability, which will be different from clinic to clinic. Local sleep facilities
for children are not currently available, although may be available in the next 1-2 years. The
closest other facilities that admit children are in Toronto at The Hospital for Sick Kids, Youthdale
Child and Adolescent Clinic as well as some others. Your doctor can arrange for consultation
and perhaps investigation at those clinics.
Dr. Colin Shapiro runs the Youthdale Child and Adolescent Clinic and has been involved both in
research and seeing children clinically for over 25 years. Dr. Shapiro is a qualified sleep
specialist for both adults and children and has agreed to assist in the set up of this clinic in
London. He will see the children in the office at 239 Oxford Street London. If sleep testing is
required he will discuss testing options in Toronto or here in London. Dr. Shapiro will also follow
up with the results of the tests in London and make recommendations to your physician for
further investigation (such as seeing an ENT physician) or other testing/treatment options.
This clinic is starting with children ages 4 and older.
Referrals
Referrals can be made for initial screening to myself (Dr. Brian Lyttle) or Dr. Shapiro. A referral
form is available on this website as well as the questionnaires that will be required for the initial
visit. The questionnaires can redone prior to the visit or in the office, and take approximately
30-45 minutes to complete.
physician and diagnostic testing. The clinic also hopes to increase the awareness of sleep
apnea in children as well as the complications associated with sleep apnea. Pediatric sleep
apnea is a relatively new field, with testing beginning in the 1980s and significant research
coming only within the last 10 years. Most physicians do not have any training in the field of
sleep apnea.
Sleep disordered breathing includes a wide range of problems, including insomnia, narcolepsy,
parasomnias, circadian rhythm problems as well as obstructive sleep apnea. The most urgent
local need is the identification of those with obstructive sleep apnea (OSA) and the recognition
of OSA complications in children who go untreated. This clinic will be available for all sleep
disorder concerns, but focus on OSA.
What is OSA?
OSA is when the back of the patient’s throat (upper airway) closes while the child is trying to
breathe in and either less air (hypopnea) or no air (apnea) occurs. When hypopnea or apnea
occurs, the body will react to overcome the obstructed airwave, causing the child to briefly
awaken. This awakening, which is rarely recalled, can happen many times a night and greatly
reduce the child’s quality of sleep. This lack of restorative sleep can result in difficulties with
getting up in morning, concentrating at school, daytime tiredness, changes in behaviour, and
changes in academic performance, as well as many other problems.
Some behavioural symptoms associated with childhood OSA can resemble and be misidentified
as ADHD. Subsequently, treatment of OSA can resolve these symptoms.
It is believed that children with undiagnosed OSA are more likely to develop anxiety and
depression during their adolescence, as well as affecting their academics throughout. In adults,
and perhaps children, OSA is known to result in high blood pressure, coronary heart disease
and metabolic syndromes like diabetes, among other maladies.
OSA in children often presents itself with excessive snoring, and there are several easy
screening tests to suggest it is sleep apnea. These screening tests can be found in your
doctor’s office, online, or downloaded from this website.
However, screening tests do not offer a comprehensive analysis, and they are what the name
implies; simply a screening to determine who does, or does not, have OSA. Unfortunately,
neither the screening test nor an extensive review of the patient’s history by a qualified sleep
analyst, is as accurate as laboratory testing. For example, 15% of children with significant
apnea do not snore, and therefore would not be identified without laboratory testing. Even
formal sleep testing must be interpreted in the light of the patient’s history and physical
examination.
In children, the most common cause of significant sleep apnea are enlarged tonsils and
adenoids. Other complications of enlarged adenoids are problems hearing, frequent ear
infections, and chronic upper airway infections, which can need surgery to resolve.
Sometimes these symptoms are not present and if the patient has suggestive symptoms of poor
sleep, it then becomes important to confirm sleep apnea. Sleep apnea can only be confirmed by
a sleep study.
Sleep Study Access
The main problem with diagnosing sleep apnea is the lack of access to sleep studies. Currently,
some adult sleep labs will accept children over the age of 12 years. You can speak to your
physician about that availability, which will be different from clinic to clinic. Local sleep facilities
for children are not currently available, although may be available in the next 1-2 years. The
closest other facilities that admit children are in Toronto at The Hospital for Sick Kids, Youthdale
Child and Adolescent Clinic as well as some others. Your doctor can arrange for consultation
and perhaps investigation at those clinics.
Dr. Colin Shapiro runs the Youthdale Child and Adolescent Clinic and has been involved both in
research and seeing children clinically for over 25 years. Dr. Shapiro is a qualified sleep
specialist for both adults and children and has agreed to assist in the set up of this clinic in
London. He will see the children in the office at 239 Oxford Street London. If sleep testing is
required he will discuss testing options in Toronto or here in London. Dr. Shapiro will also follow
up with the results of the tests in London and make recommendations to your physician for
further investigation (such as seeing an ENT physician) or other testing/treatment options.
This clinic is starting with children ages 4 and older.
Referrals
Referrals can be made for initial screening to myself (Dr. Brian Lyttle) or Dr. Shapiro. A referral
form is available on this website as well as the questionnaires that will be required for the initial
visit. The questionnaires can redone prior to the visit or in the office, and take approximately
30-45 minutes to complete.
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