Pediatric Obstructive Sleep Apnea (OSA) Presenting as Academic Decline and Daytime Somnolence: A Case Study of a 10-Year-Old with Slipping Grades

This case study examines a 10-year-old female, Avery Brook, who presents to an outpatient clinic with a four-month history of "slipping grades," progressive academic decline, cognitive fog, difficulty concentrating, and significant daytime somnolence. Initial differential diagnoses included Obstructive Sleep Apnea (OSA), hypothyroidism, and ADHD inattentive type. Physical examination revealed 3+ tonsillar hypertrophy and dark circles under the eyes (allergic shiners). Diagnostic workup, including a polysomnography (sleep study), confirmed pediatric OSA with an Apnea-Hypopnea Index (AHI) of 6 events/hour. Laboratory tests ruled out hypothyroidism (normal TSH/T4) and anemia, while Vanderbilt Assessment scores were subthreshold for ADHD. The case demonstrates how sleep fragmentation from OSA can manifest as cognitive impairment and academic difficulties, mimicking attention disorders. The management plan includes fluticasone nasal spray, otolaryngology (ENT) referral for potential tonsillectomy and adenoidectomy (T&A), sleep hygiene education, and close follow-up. This case highlights the importance of considering OSA in children presenting with declining school performance and fatigue.