Sleep-Disordered Breathing: Not Just a Grown-Up Problem

Despite the old adage, "sleeping like a baby," we know that children are at risk for many of the same sleep disorders as adults. Sleep-disordered breathing is a problem among children -- even very young children. This news reveals some of the negative consequences of untreated sleep-disordered breathing in children.

In a study of the sleep, breathing and behavioral development of more than 11,000 children, researchers at Yeshiva University's Albert Einstein College of Medicine have found that those children with sleep-disordered breathing were more likely to develop behavioral problems and emotional problems, and also to have greater difficulty with peer relationships.

Researchers relied on information gathered from parent questionnaires. Parents answered questions about their children's sleep and breathing, starting from the time their children were 6 months old, and repeating regularly until their children were nearly 7 years old. Parents also provided information about their children's behavioral and emotional development, in questionnaires given when children were 4 years old, and again at age 7. The behavioral and emotional development issues addressed included:

• Hyperactivity
• Anxiety and depression
• Problems with peers
• Conduct issues, including aggressiveness and rule-breaking
• Positive social behaviors, including sharing and helpfulness

Researchers found that children with sleep-disordered breathing were significantly more likely to have behavioral and emotional problems than children without disordered breathing.

• Children with sleep-disordered breathing were 40 to 100 percent more likely to have behavioral problems by the age of 1 year.
• Hyperactivity was the behavioral issue that increased the most with disordered breathing, but all behavioral problems showed significant increase.
• Children with the most severe behavioral problems also had the most persistent sleep-disordered breathing throughout the six-year evaluation period

The results of this large-scale study provide strong evidence of a link between sleep-disordered breathing and behavioral problems. But these results don't tell us why sleep-disordered breathing is likely to be affecting children's behavior and emotional development. The scientists who conducted the study believe that several factors may be involved. These factors include:

• Decreased oxygen (and increased carbon dioxide) to the child's brain during periods of breathing-disordered sleep
• A lack of restorative sleep
• Changes to body chemistry and cell development as a result of sleep deprivation and/or the disordered breathing itself

What, exactly, is sleep-disordered breathing? It's actually a group of conditions, each of which interrupt or diminish airflow. Sleep-disordered breathing conditions include snoring, mouth breathing and sleep apnea. These may seem like issues for adults only, but in fact they're all-too-common problems for children as young as toddlers, and even younger. This recent study found sleep-disordered breathing in children as young as 6 months. Observing children ages 6 months to 6.75 years, the study found:

• Chronic sleep apnea among 1 to 2 percent of children at all age levels
• "Habitual" snoring among as many as 21 percent of children
• An increase in the frequency of snoring in children between the ages of 1.5 and 2.5 years
• Mouth breathing in 25 percent of children by the age of 6

Recent research, including this latest study, is giving us a clearer picture of the negative effects of sleep-disordered breathing and poor sleep on child development and behavior. Other recent research has shown:

• Children who exhibit aggressive behavior at school are twice as likely to have a sleep-disordered breathing condition as children who don't show aggressive behavior.
• Children with sleep-disordered breathing are more likely to have cognitive deficits compared to children without breathing disorders. These deficits existed regardless of the degree of severity of the breathing problem.
• By the time kids reach adolescence, sleep problems are associated with a long and troubling list of risky and unhealthful behaviors, including fighting, smoking cigarettes and marijuana, drinking alcohol and coping with feelings of sadness, hopelessness and suicide.

This is a critically important area of study that needs more attention. The more we know about how sleep-disordered breathing affects children's behavioral, emotional and intellectual development, the better we'll be at stepping in to treat and prevent the problem before it becomes serious.

As parents, there are some basic, and important, steps you can take to help protect and improve your children's sleep:

• Set a sleep schedule and stick to it. Regular bedtimes, and nighttime routines that help a child prepare for bed, are a critical part of helping our kids develop strong sleep habits.
• Make their bedrooms sleep-friendly. I can't say this enough: Keep the electronics out of the bedroom. Kids' bedrooms should be dark, quiet places for rest -- not a haven for television, video games, laptops and cellphones.
• Talk to you doctor. Make sleep a regular part of the conversation with your child's physician. Get specific -- ask your pediatrician about sleep-disordered breathing, and what steps to take if your child is exhibiting symptoms.

Sleep-disordered breathing in children, no matter how mild it appears, should never be ignored. By addressing these issues before they become serious, we can help keep our kids sleeping well and growing well.

Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Comments

[alenmathew]

06:20 AM on 04/11/2012

Hey even i have heard about sugar free diet, many people having sleep apnea have found the difference with the help of sugar free diet.

[hharrison22]

07:24 PM on 04/10/2012

We pass on lots of things to our children. My son happened to receive my sleep apnea as well as my sleepwalking/sleeptalking tendencies. Needless to say, he's never "slept like a baby." Thankfully, I had a pretty good idea that we would have sleep difficulties so I've been really diligent about sleep habits since day one. I'm pretty sure it's helped.

"The child psychologist who thought she had all the answers to parenting until she became one herself." www.themommypsychologist.com

[poomplet]

02:36 PM on 04/10/2012

I'll never forget how scary it was when we vacationed in Siesta Key FL with our then-4 yo son (now 11). We'd noticed some snoring before, and knew he had allergies, but nothing could prepare us for what happened when he slept in our room during a red tide.

It was full-fledged apnea, where he would sometimes stop breathing during his non-stop snoring. The minute we got home, we saw an ENT Md. & learned his adenoids were really over-sized. He went in to have them removed, along with his tonsils...and then some ear-tubes for the trifecta.

Ever since, his sleep has been as normal as can be. So if your child does have any sleep-disorder symptoms, make sure you check out the adenoids!

[EinsteinMed]

10:36 AM on 04/10/2012

Thanks for mentioning Albert Einstein's research in your post, Dr. Breus. For more information, check out an interview we conducted with Karen Bonuck, Ph.D., the lead author of that research at http://bit.ly/A4hHPG

[EinsteinMed]

10:31 AM on 04/10/2012

Thanks for mentioning Albert Einstein College of Medicine's research in your post, Dr. Bruess! To see a brief interview we did with Karen Bonuck, Ph.D., the lead author of this paper, please visit our blog, The Doctor's Tablet at http://bit.ly/A4hHPG.

[Christine Shackleton]

10:02 AM on 04/10/2012

This perhaps accounts or relates to the statistic of the biggest killer of children is cardiac arrest. Similarly the lack or fear of posting to this story could involve anthropological dimensions and tribal lthought and including its lack as mentioned by Emile Durkheim

[lydiad]

08:34 AM on 04/10/2012

I want to pass on something that my family just learnt. My husband and son in law have sleep apnea, quite badly. Recently, for different reasons both of them went on a gluten free and sugar free diet unrelated to the sleep apnea and we discovered that both of them started to sleep normally and much better. It was almost immediate. The apnea is almost gone for them both. A wonderful benefit to the diet.