Disorders Relating to the Airway and Mouth in Sleep (DREAMS) Clinic

The DREAMS Clinic is a specialized clinic for the assessment and treatment of children and adolescents with complex sleep-disordered breathing. The experienced team includes respirologists/sleep physicians, otolaryngologists (head and neck surgeons), neurosurgeons, plastic surgeons, paediatric orthodontists, neuroradiologists, MRI technicians, anesthesiologists, a nurse practitioner and a respiratory therapist. We provide a multidisciplinary approach to managing complex obstructive sleep apnea, which may include surgical and non-surgical options. 

What to bring: 

• If your child is on a BiPAP or CPAP machine, it is important that you bring the machine and mask to the appointment. We may want to download the information stored on the machine. 

Directions: 

The DREAMS Clinic is located in Room 6109, on the 6th floor of the Burton Wing. 

You will meet with members of the DREAMS Clinic team during your appointment. The core team includes an otolaryngologist, a respirologist/sleep physician and a nurse practitioner. If required, you may also meet with a respiratory therapist and/or an Otolaryngology Clinic nurse. Depending on your child’s specific condition, there may be other members of the team present. 

The initial appointment in the DREAMS Clinic will involve a review of the patient’s medical history, which may include sleep history, past surgical interventions and previous and/or current treatments for obstructive sleep apnea. The otolaryngologist will complete a thorough examination of your child’s ears, nose, mouth and throat. In most cases, we will then bring you to another room where the otolaryngologist will perform a nasal endoscopy. This involves placing a very small flexible camera down your child’s nose to look at the back of the throat and voice box. This allows the DREAMS Clinic team to see parts of the upper airway that would otherwise not be visible and provides us with valuable information which helps the team decide about appropriate treatment options for obstructive sleep apnea.

During the nasal endoscopy, the patient is awake and the parent is present throughout the whole procedure. A member of the DREAMS Clinic team may help hold the patient during the nasal endoscopy. The nasal endoscopy may feel uncomfortable during the procedure itself, but the discomfort will resolve once the scope is removed. If the patient is tolerating the nasal endoscopy, the otolaryngologist may ask the patient to lie down during the nasal endoscopy.

Once the nasal endoscopy is complete, the DREAMS Clinic team will review the findings of the nasal endoscopy with the patient and parents and discuss recommended management options, which may include introduction of medications, imaging such as an MRI or a Sleep MRI, positive airway pressure therapy (CPAP/BiPAP) and/or surgical interventions. 

You will have lots of time to ask questions and give feedback on your child’s management plan. At the end of the appointment, if surgical intervention is recommended, you will meet with the Otolaryngology Clinic nurse to complete pre-operative paperwork. 

Because we want to give each patient as much time as they need to be thoroughly examined and to have all of their questions answered, please expect to be at the hospital for approximately 3 hours. Your child may be required to do extra testing, to see other members of the Sleep Disorders Team and/or you may be waiting for your appointment due to circumstances beyond our control. 

More information: 

Visit Department of Otolaryngology - Head and Neck Surgery