A recently concluded research study findings are important for parents who often think that snoring babies are deeply sleeping ones. This research however revealed that snoring, along with mouth-breathing and sleep apnea, are sure symptoms of disordered sleep and the chances of developing long-term problems in children’s behavior and emotional well-being are quite high.

Findings of this research study have been published in the journal Pediatrics, researchers say that babies who have these sleep problems at 6 months may be anywhere from 20% to 100% more likely to have problem behaviors such as hyperactivity by age 7.

The study was conducted with more  than 11,000 children followed for over six years at the at Albert Einstein College of Medicine of Yeshiva University and the researchers found that young children with sleep-disordered breathing are prone to developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships.

Sleep habits and combined effects of snoring, sleep apnea and mouth-breathing patterns on the behavior of children of more than 11,000 children born in 1991-92 in the former county of Avon in England was analyzed.

The children’s parents were enrolled during pregnancy, and filled out questionnaires about once a year, starting when their children were 6 months old, about whether they snored, breathed through their mouth, or stopped breathing for a few seconds at a time (sleep apnea) while they slept.

Parents also completed a screening test for their children at ages 4 and 7 that assessed emotional and behavioral symptoms in five different areas — hyperactivity, emotional problems (such as anxiety and depression), difficulty in getting along with their peers, conduct disorders (such as aggressiveness) and sharing and helpful tendencies.

The children who had the worst sleep disorder symptoms — those that peaked at age 2.5 and persisted — showed scores consistent with clinical diagnoses of behavioral disorders like ADHD at both age 4 and age 7.

The study’s lead author, Karen Bonuck of Albert Einstein College of Medicine, says she and her team also controlled for 15 factors that could contribute to either snoring or sleep apnea, as well as behavioral difficulties, including mother’s education, family adversity, mother’s smoking or alcohol use while pregnant, and the nature of father’s employment (manual or professional job). None of these factors seemed to affect the consistent relationship between sleep disorders and later behavioral problems.

Sleep is a time to restore the brain’s cellular and chemical homeostasis. When sleep is disordered, the brain receives less oxygen than it needs, and may get more carbon dioxide than it needs. That may lead to developmental disruptions in the prefrontal cortex, the region responsible for regulating higher-level functions such as planning and organization. Interruptions in oxygen at younger ages may be even more damaging than at later ages. Since the brain is still developing and forming the neural connections it needs to establish complex behaviors like emotional regulation and social conduct.

Bonuck suggests that parents who are concerned about their children’s consistent snoring — a problem that often arises from enlarged tonsils or adenoids — should discuss it with their pediatrician. Treatment may help reduce social and emotional problems later on — and lead to quieter nights’ sleep.

“This is the strongest evidence to date that snoring, mouth breathing, and sleep apnea can have serious behavioral and social-emotional consequences for children,” said study leader Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women’s health at Einstein.

“Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Sleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. Its hallmarks are snoring, mouth breathing, and sleep apnea. SDB reportedly peaks from two to six years of age, but also occurs in younger children. About 1 in 10 children snore regularly and 2 to 4 percent have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids.

“Until now, we really didn’t have strong evidence that SDB actually preceded problematic behavior such as hyperactivity,” said Ronald D. Chervin, M.D., M.S., a co-author of the study and professor of sleep medicine and of neurology at the University of Michigan.

 “We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems. The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures”, said Dr. Karen Bonuck.

Children whose symptoms peaked early—at 6 or 18 months—were 40 percent and 50 percent more likely, respectively, to experience behavioral problems at age 7 compared with normally-breathing children. Children with the most serious behavioral problems were those with SDB symptoms that persisted throughout the evaluation period and became most severe at 30 months.

Sleep disordered Breathing (SDB) could cause behavioral problems by affecting the brain in several ways: decreasing oxygen levels and increasing carbon dioxide levels in the prefrontal cortex; interrupting the restorative processes of sleep; and disrupting the balance of various cellular and chemical. Behavioral problems resulting from these adverse effects on the brain include impairments in executive functioning (i.e., being able to pay attention, plan ahead, and organize), the ability to suppress behavior, and the ability to self-regulate emotion and arousal.

“Although snoring and sleep apnea are relatively common in children, pediatricians and family physicians do not routinely check for sleep-disordered breathing.In many cases, the doctor will simply ask parents, ‘How is your child sleeping?’ Instead, physicians need to specifically ask parents whether their children are experiencing one or more of the symptoms—snoring, mouth breathing or sleep apnea—of SDB,” said Dr. Bonuck

“If parents suspect that their child is showing symptoms of SDB, they should ask their pediatrician or family physician if their child needs to be evaluated by an otolaryngologist (ear, nose and throat physician) or sleep specialist”, said Dr. Bonuck.

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