The more young children snore, breathe through their mouths or stop breathing while asleep for a few seconds at a time, the more likely they are to develop behavioural problems, a new study shows.
Previous research had suggested a link between these 'sleep-disordered breathing' symptoms and such problems as hyperactivity, but the authors of the new study say theirs is by far the largest and most comprehensive of its kind.
One expert said the findings suggest that some children with sleep disorders are sometimes wrongly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
The study
The researchers followed more than 11,000 children in an ongoing study in southwest England. The Avon Longitudinal Study of Parents and Children enrolledpregnant women who were due to deliver between April 1991 and December 1992.
For the latest findings, researchers asked parents to fill out questionnaires about their children’s snoring, mouth breathing, and apnoea, which refers to abnormal pauses in breathing while asleep.
The questionnaires were completed when the children were six, 18, 30, 42, 57, and 69 months of age. When their children were four and seven years old, the parents were asked to complete questionnaires about their children’s behaviour.
Around 45% of the children breathed normally while asleep, according to their parents. Of the rest, the 'worst case' children had elevated levels of all three breathing symptoms at 30 months of age, says researcher Karen Bonuck, a professor of family and social medicine at Albert Einstein College of Medicine in New York.
Aggressiveness, anxiety and depression
After accounting for 15 other factors linked to behavioural problems, such as low birth weight and mother's education, the researchers found that children with sleep-disordered breathing were 40% to 100% more likely to experience behavioural problems at the age of seven than children without breathing problems.
The worse their breathing symptoms, the greater their risk of such problems as hyperactivity, behavioural problems including aggressiveness and rule-breaking,anxiety and depression, and difficulty getting along with their peers.
Despite the research linking snoring to behavioural problems, more than half the parents surveyed at one hospital’s primary care clinic said they thought it was a sign of healthy sleep in children, according to a report last year in the Journal of Developmental and Behavioral Pediatrics.
Parents 'should pay closer attention' to sleep
“The take away is that parents need to pay closer attention to their child’s breathing while their sleeping,” Karen Bonuck tells us. Scientists have many theories about why sleep-disordered breathing increases children’s risk of behavioural problems, she says. Infancy and young childhood are key periods of brain development, and breathing problems might decrease oxygen in the brain. Plus, the authors note, breathing problems could interrupt the restorative processes of sleep and disrupt the balance of various cellular and chemical systems.
The latest research appears in the online edition of the journal Pediatrics.
"It's a very good study," says Marianne Davey, co-founder of the British Snoring and Sleep Apnoea Association, "and it's alerting us to the fact that children with sleep disorders do tend to get this label of having ADHD wrongly".
"It's a very good study," says Marianne Davey, co-founder of the British Snoring and Sleep Apnoea Association, "and it's alerting us to the fact that children with sleep disorders do tend to get this label of having ADHD wrongly".
Sleep problems and hyperactivity in children
She explains that children who experience snoring and sleep apnoea, and the sleep deprivation that goes with it, tend to display opposite symptoms to an adult with the same condition. "Your typical adult with sleep apnoea would be your overweight,smoking, drinking, middle-aged male, and the consequence of that would be day time sleepiness - can't function at work, can't function at home. Children, on the other hand, tend to be hyperactive, and display bad behaviour [and] lack of concentration," she tells BootsWebMD.
Marianne Davey says the most common reason for snoring in very young children between the ages of three and five is an imbalance between the size of the tonsilsand adenoids compared with the size of the airways. "The tonsils and adenoids are almost adult sized by the time a child is about three," she says, "whereas their airway is the size of a three year old."
Her advice is to wait until a child is about eight years old to see if the problem resolves itself, before considering further investigations. "You don't want the snoring to go on for too long, because a snoring child will not function very well at school because they'll be tired," she says. However she adds, "the other side of it is you don't want to be taking out tonsils and adenoids unnecessarily".
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