Children with breathing difficulties are being overlooked

EDITOR—I was disappointed to see that once again children with sleep disorders are being lumped into a homogeneous group of children with “behavioural” problems, then “studied” without using polysomnography. I think it's presumptuous and dangerous to think that every child who has trouble sleeping has a behavioural problem. Few physicians are aware that breathing difficulty can cause night waking and bedtime resistance, and it is because of studies like that of Ramchandani et al.1

Doctors don't look for sleep disorders properly, don't know much about them, and are told repeatedly that behavioural treatments are the appropriate treatment. This is wrong unless we can guarantee that the children have behavioural problems. A study looking at obese children using polysomnography diagnosed unsuspected obstructive sleep apnoea in 75% of the children studied—meaning the physicians examining the children picked up only 1 in 4 cases. It therefore seems a big leap of faith not to be doing polysomnography more often. Some of the children waking at night could have upper airways resistance syndrome, which can also cause sleep problems. Most doctors can barely take a proper history for sleep disorders, let alone diagnose a subtle case of upper airways resistance syndrome causing repeated night waking or bedtime resistance. Studies like that of Ramchandani et al certainly don't help because they take the emphasis away from finding a “real physiological” problem and on to stress behavioural modification.

Before we continue to send physicians out to behaviourally modify breathing difficulties or other subtle causes of sleep disorders that can mimic behavioural problems, we need to do polysomnography on these children.

Night waking is natural behaviour

EDITOR—The basic assumption of the study of Ramchandani et al that very young children should settle down to sleep away from their parents and not be seen or heard from again until morning is flawed.1 …