I have an eight-year-old boy who has a history of enlarged tonsils and adenoids. He sleeps with his head at an odd angle and mouth-breathes. He also wets the bed several times a week. Could the bedwetting be related to the poor sleeping and mouth breathing? He is a happy, healthy, well-adjusted child.

G.M.P.

Yes, there could be such a link, if he has obstructive sleep apnea (OSA). OSA in children is somewhat different from OSA in adults. However, at all ages, OSA is a condition in which airway blockage during sleep leads to extremely poor sleep quality, which in turn may lead to high blood pressure, daytime sleepiness and personality disorders (as a consequence of sleep deprivation). If people with severe OSA are not treated, they may develop heart failure and a nasty lung condition known as pulmonary hypertension. In adults, some cases of sudden death from stroke or heart attack are attributed to untreated OSA; in infants, some cases of sudden infant death syndrome may be due to OSA.

Bedwetting is one symptom of OSA in children. The most common symptoms, however, are loud snoring and obvious apneas. "Apnea" (pronounced AP-nee-uh) means "no breath" -- he stops breathing, in other words. This is usually very obvious: the child will snore loudly, then stop suddenly. What follows is either silence or a "choking" noise, eventually followed by a loud gasp, when the child finally manages to take a breath.

Aside from snoring, apneas and bedwetting, other symptoms of childhood OSA are mouth breathing, nightmares or "night terrors," night sweats, morning headache, chronic runny nose (due to enlarged adenoids), feeding difficulties (due to enlarged tonsils), and behavior problems. Some cases of attention deficit hyperactivity disorder can be attributed to OSA. Certainly, children with OSA have a short attention span and may do poorly in school due to their sleepiness.

In adults, the treatment of choice for OSA is CPAP (continuous positive airway pressure), a device that uses pressurized air to help keep the airway open during sleep. Surgery is recommended only if the adult cannot tolerate CPAP, or if there is an obvious, correctable anatomical problem -- large tonsils and adenoids, for example. This is an uncommon problem in adults, but in children, big tonsils and adenoids are the cause of most cases of OSA. Thus, children rarely need CPAP. Tonsillectomy/adenoidectomy is usually enough to cure the problem.

The fact that your son "sleeps with his head at an odd angle" is also significant. His airway is so poor that he must optimize it by sleeping in an unnatural position. I suggest that you discuss these matters with your son's doctor as soon as possible.