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Snoring kids likelier to have behavioural problems later in life


March 5, 2012 - Washington

Young children with sleep-disordered breathing are prone to developing behavioural difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships.

This is the finding of a study by researchers at Albert Einstein College of Medicine of Yeshiva University, who followed more than 11,000 children for over six years.

"This is the strongest evidence to date that snoring, mouth breathing, and apnea [abnormally long pauses in breathing during sleep] 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 and 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," Bonuck noted.

Sleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. Its hallmarks are snoring (which is usually accompanied by mouth breathing) and sleep apnea.

SDB reportedly peaks from two to six years of age, but also occurs in younger children. Common causes of SDB are enlarged tonsils or adenoids.

"Until now, we really didn't have strong evidence that SDB actually preceded problematic behaviour 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.

"Previous studies suggesting a possible connection between SDB symptoms and subsequent behavioural problems weren't definitive, since they included only small numbers of patients, short follow-ups of a single SDB symptom, or limited control of variables such as low birth weight that could skew the results. But this study shows clearly that SDB symptoms do precede behavioural problems and strongly suggests that SDB symptoms are causing those problems," he stated.

The new study analysed the combined effects of snoring, apnea and mouth-breathing patterns on the behaviour of children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

"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 behavioural measures," said Dr. Bonuck.

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

Researchers believe that SDB could cause behavioural 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 systems.

Behavioural 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 behaviour, and the ability to self-regulate emotion and arousal.

"Although snoring and apnea are relatively common in children, pediatricians and family physicians do not routinely check for sleep-disordered breathing," said Dr. Bonuck.

"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 apnea-of SDB.

"As for parents, if they 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," Dr. Bonuck added.

The findings have been published online in the journal Pediatrics.

ANI

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