Snoring Toddlers May Become Hyperactive or Aggressive Kids
Young children who have breathing problems during sleep, such as snoring and mouth breathing, are much more likely to have behavioral issues in their early elementary years, finds a new study conducted at the Albert Einstein College of Medicine at Yeshiva University.
Sleep-disordered breathing, or SDB, is the general term for breathing difficulties that occurring during sleep. The hallmarks of the condition are snoring, which is usually accompanied by mouth breathing, and a more serious condition called sleep apnea where breathing actually stops for a short period of time several times during the night. According to the American Academy of Otolaryngology, about one in ten children snore regularly and 2 to 4% have sleep apnea.
Lead researcher Karen Bonuck, a family medicine expert, and colleagues followed more than 11,000 children for six years who were enrolled in the Avon Longitudinal Study of Parents and Children in the UK. For the study, parents were asked to fill out questionnaires about their children’s SDB symptoms at various intervals from 6 to 69 months of age. When the children were between the ages of four and seven years, the parents filled out the Strengths and Difficulties Questionnaire which is widely used to asses behaviors such as inattention/hyperactivity, emotional symptoms such as anxiety or depression, and conduct problems (aggression and rule-breaking).
Overall, "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," said Dr. Bonuck. "The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures."
Children who had the most serious behavioral problems were those whose SDB symptoms had persisted throughout the evaluation period and became most severe at 30 months. However, children who peaked early – at 6 to 18 months -= were still 40-50% more likely to have issues.
Patients who have breathing problems such as sleep apnea experience daytime fatigue, slower reaction time, and vision problems the next day. There is also an effect on executive function, the part of the brain that handles planning and initiating tasks. Additionally, attention, memory and learning are often disrupted. All of these can lead to the behavioral problems seen in the children in their early elementary years.
Sleep disordered breathing is also known to increase the risk for cardiovascular disease, high blood pressure and diabetes.
Thankfully, there is an easy solution to the problem, says Dr. Bonuck. "Parents who suspect their child has breathing difficulties during sleep should ask their pediatrician or family physician if the child needs to be evaluated by an otolaryngologist (ear, nose and throat doctor) or sleep specialist," she said.
The most common causes of breathing problems include enlarged tonsils and adenoids, which can be surgically removed, and obesity, which can be reversed with a healthy diet and adequate physical activity. Other conditions that cause disordered breathing including skull and facial deformities and an inability of the brain to control breathing.
"Our evidence appears to provide the strongest evidence to date that [sleep disorders] do play a causal role and therefore reducing these symptoms particularly early in life is likely to have some benefit in reducing future problems," concludes Dr. Bonuck.
Bonuck K, et al. "Sleep-disordered breathing in a population-based cohort: Behavioral outcomes at 4 and 7 years"Pediatrics 2012; 129: 1–9.
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