Spontaneous resolution of obstructive sleep ap nea hypopnea has been reported with weight
loss, particularly after bariatric surgery. In children, seasonal va riation in obstructive sleep ap-
nea hypopnea has been observed, as has improvement with overall growth.
In young children, the signs and symptoms of obstructive sleep apnea hypopnea may be
more subtle than in adults, making diagnosis more difficult to establish. Polysomnography is
useful in confirming diagnosis. Evidence of  fragmentation of sleep on the polysomnogram
may not be as apparent as in studies of older individuals, possibly because of the high homeo-
static drive in young individuals. Symptoms su ch as snoring are usually parent-reported and
thus have reduced sensitivity. Agitated arousals and unusual sleep postures, such as sleeping
on the hands and knees, may oc cur. Nocturnal enuresis also may occur and should raise the
suspicion of obstructive sleep apnea hypopnea if it recurs in a child who was previously dry at
night. Children may also manife st excessive daytime sleepiness, although this is not as com-
mon or pronounced as in adults. Daytime mouth breathing, difficulty in swallowing, and poor
speech articulation are also common features in children. Children younger than 5 years more
often present with nighttime symptoms, such as  observed apneas or labored breathing, than
with behavioral symptoms (i.e., the nighttime symptoms are more noticeable and more often
bring the child to clinical attention). In childre n older than 5 years, daytime symptoms such as
sleepiness and behavioral problems (e.g., impulsivity and hyperactivity), attention-deficit/
hyperactivity disorder, learning  difficulties, and morning head aches are more often the focus
of concern. Children with obstructive sleep apnea hypopnea also may present with failure to