Refractory Sleep Apnea (Pediatric)

The Pediatric Refractory Sleep Apnea Clinic at C.S. Mott Children’s Hospital is one of the few multidisciplinary sleep programs for children in the nation.  It was formed to provide comprehensive, multidisciplinary evaluation and treatment plans for pediatric patients with an established diagnosis of obstructive sleep apnea (OSA).

To be seen in the clinic, patients must have a diagnosis of OSA, which requires a sleep study. A repeat sleep study may be requested to confirm the diagnosis, preferably in one of our dedicated pediatric facility. Pediatric sleep studies are conducted at the Med Inn location within the University of Michigan Medical Complex, the Brighton Center for Specialty Care, or for older healthy children, at Domino’s Farms.

Who Will I Meet with During My Visit?

During your visit to the Pediatric Refractory Sleep Apnea Clinic, you will meet with and be evaluated by members of our experienced team:

  • A pediatric sleep medicine specialist
  • A pediatric ear, nose and throat (ENT) surgeon
  • A pediatric oral and maxillofacial surgeon (OMFS)
  • A pediatric orthodontist

What Can I Expect on the Day of the Visit?

Your child’s evaluation will take place in two clinic locations. 

Mott Otolaryngology Clinic

At the Mott Otolaryngology clinic, you will be seen by a pediatric sleep medicine specialist and a pediatric otolaryngologist (ear, nose and throat) surgeon together.

Pediatric Sleep Medicine Specialist

The sleep medicine specialist will review the results of your child’s sleep study if available, and will discuss his or her sleep history with you.

The goal of the sleep medicine specialist is to understand your concerns about your child’s sleep and whether non-surgical therapies - such as oxygen by nasal cannula or positive airway pressure therapy using continuous positive airway pressure (CPAP) - may be an option to treat their sleep apnea. Occasionally some other treatment options that are not frequently used may be discussed such as positional therapy. 

Pediatric Otolaryngologist (Ear, Nose and Throat [ENT] Surgeon)

Your evaluation with an ENT surgeon begins with a medical history and physical exam.

Your child may undergo a nasopharyngoscopy. This is a diagnostic procedure using an endoscope attached to a bright light to look through the nose into the nasal passages and far back into the throat. Sometimes a nasal spray is used prior to insertion of the scope to shrink and numb the nasal passages. This frequently performed exam provides a more thorough look at the nose, mouth and throat in order to diagnose problems that are otherwise difficult to observe.

The goal of the Otolaryngologist (ENT surgeon) is to determine whether your child may benefit from surgical treatment of the soft tissues of the airway.

Mott Oral and Maxillofacial Surgery clinic

At the Mott Oral and Maxillofacial Surgery clinic, you will be seen by a pediatric oral and maxillofacial surgeon as well as a pediatric orthodontist.

Oral and Maxillofacial Surgeon (OMFS)

An Oral and Maxillofacial specialist will evaluate your child to assess how his or her unique jaw structure, facial bones and oral soft tissue anatomy may be contributing to airway obstruction and sleep apnea.

A maxillofacial cone beam computed tomography (CBCT) is a type of low radiation 3-D scan which may be used to image the upper part of the neck, jaw, facial bones, sinuses and the upper airway to assess risk factors for obstruction. Alternatively, X-rays of the face may be taken to assess the airway and facial bones.

Using 3-D airway analysis software, the OMF surgeon can compute the volume of the upper airway and locate the narrowest cross-sectional area to determine where the airway obstruction is occurring. This imaging also demonstrates the position of the jawbones relative to the skull. This information is used to determine if your child may benefit from surgical repositioning of the upper or lower jaw or tongue base.


The evaluation entails an extraoral and intraoral examination to determine if your child’s teeth, gums, and soft tissue are healthy. The orthodontist will evaluate how your child’s teeth come together and whether dental crowding may be contributing to their sleep apnea.  The goal of the orthodontist will be to determine the potential benefits, limitations and consequence of orthodontic treatment for your child’s sleep apnea.

The multidisciplinary team of providers then meets together to discuss your child’s individual case, reviewing any relevant imaging and the video of your child’s nasal endoscopy.  The team will then formulate a stepwise treatment plan which will be discussed with you over the phone.

Make an appointment

To schedule an appointment at the multidisciplinary Pediatric Refractory Sleep Apnea clinic, please call 734-615-4302. A physician referral is required prior to your appointment date.