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The staff from the Respiratory Team are taking this opportunity to invite you into the mysterious world of sleep. Things really do go bump in the night but many people will be more familiar with the sound of snoring from their nearest and dearest.

The condition that most people are aware of and can be associated with snoring, is obstructive sleep apnoea (OSA).

OSA is a condition that can affect any age group. When a person has OSA, their airway occludes either partially or completely due to upper airway obstruction. This can result in their oxygen levels falling and it will also send a signal to the brain which makes the patient stir so that their airway opens again. Once they settle back to sleep, the whole process starts all over again. This is why, when a patient wakes up in the morning they don’t feel refreshed. Their night was spent trying to breathe, rather than sleeping.

The incidence of OSA in the general paediatric population is between 1% - 3% (RCPCH 2009). This means that approximately 10,000 - 30,000 children in Ireland have OSA. In certain patient groups OSA can be even more prevalent e.g. up to 60 % children with Down syndrome may also have OSA.

Patients with neuromuscular disease, craniofacial abnormalities etc. are also at increased risk of developing OSA and these patients may undergo surveillance testing on an annual basis.

The most common symptom of OSA is snoring. Parents may also hear their child gasp or witness pauses in their breathing. They may also note that their child sleeps in an unusual position e.g. with their head tilted back or that they might be very restless when they are asleep. During the day the child may be sleepy or hyperactive. If they are of school going age, then they may have issues with concentration or behavioural issues. Children may also complain of headaches when they wake up and parents may note that they breathe through their mouth and not the nose.

The incidence of OSA tends to peak between the ages of 2-6 years. Treatment can involve removing the tonsils and adenoids however, in certain cases non-invasive ventilation (NIV) may also be used. Follow up sleep studies may also be required to see if the surgery was successful or if the NIV settings are appropriate for that patient. Once treatment has been successful, the transformation can be impressive. Parents have often reported that they can no longer hear their child snoring like an old man from downstairs and in fact their breathing is now so quiet that they have to check on them to make sure they are still breathing.

The Respiratory Team has grown from having one consultant and two physiologists in 2006 to having five consultants, five physiologists and two NIV nurses. Last year we performed 1,495 sleep studies. 811 of them were performed at home and 684 were performed as inpatients. This compares with 106 studies that were performed in 2006. Our NIV nurses have also been busy. Currently we have 450 patients on NIV, that’s over double the amount we had in 2016.

The Respiratory team accept referrals from all over the country and we have the ability to perform a variety of tests from simple oximetry to more complicated testing such as polysomnography (PSG). We also work closely with our colleagues in other hospitals, some of whom are able to do simple tests e.g. oximetry before sending the patient onto us for more in-depth testing. The majority of referrals come from the respiratory team but we also receive a large amount of referrals from other teams within the hospital, in particular neonates and general paediatrics. The demand on the service increases year on year as awareness of the condition increases and families and healthcare staff recognise the risk factors and signs of OSA.

If you or a family member have concerns about your sleep, then please contact your GP who will be able to refer you for a sleep study if necessary.

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