Sleep disorders are more common in racial/ethic minorities

According to a recent study, sleep disturbances occur more frequently in middle-aged and older adults who are racial or ethnic minorities.

A new study suggests that sleep disturbances and undiagnosed sleep apnea are common among middle-aged and older adults in the U.S., and these sleep problems occur more frequently among racial/ethnic minorities.

Results show that 34 percent of participants had moderate or severe sleep-disordered breathing measured by polysomnography, and 31 percent had short sleep duration with less than 6 hours per night measured by actigraphy. Validated questionnaires also showed that 23 percent reported having insomnia, and 14 percent reported excessive daytime sleepiness. Only 9 percent of participants reported being told by a doctor that they had sleep apnea.

After adjustment for sex, age, and study site, blacks were most likely to have short sleep duration of less than six hours, and they were more likely than whites to have sleep apnea syndrome, poor sleep quality, and daytime sleepiness. Hispanics and Chinese were more likely than whites to have sleep-disordered breathing and short sleep duration, but Chinese were least likely to report having insomnia.

"Our findings underscore the very high prevalence of undiagnosed sleep disturbances in middle-aged and older adults, and identify racial/ethnic disparities that include differences in short sleep duration, sleep apnea and daytime sleepiness," said lead author Dr. Xiaoli Chen, research fellow in the Department of Epidemiology at Harvard T.H. Chan School of Public Health in Boston.

Study results are published in the June issue of the journalSleep.

The study population was recruited from six U.S. communities and comprised 2,230 racially/ethnically diverse men and women who were between the ages of 54 and 93 years. Data gathered by polysomnography, actigraphy and validated questionnaires were obtained between 2010 and 2013.

According to Dr. Chen and her colleagues, this is the first study that has comprehensively evaluated objective measures of sleep apnea, short sleep, and poor sleep, as well as subjective measures of habitual snoring, insomnia, and daytime sleepiness in a multi-ethnic U.S. population that includes Chinese Americans. Results suggest that sleep disturbances may contribute to health disparities among U.S. adults.

"As sleep apnea has been implicated as a risk factor for cardiovascular disease, stroke, diabetes, and mortality, our findings highlight the need to consider undiagnosed sleep apnea in middle-aged and older adults, with potential value in developing strategies to screen and improve recognition in groups such as in Chinese and Hispanic populations," said senior author Dr. Susan Redline, professor of medicine at Harvard Medical School and Division of Sleep Medicine at Brigham and Women's Hospital and Beth Israel Deaconess Medical Center in Boston. The study was supported by grants from the National Institutes of Health (NIH) and an award from the National Center for Advancing Translational Sciences (NCATS).

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Short sleep and breathing issues increases obesity risk in children

A child's risk of obesity is increased by sleeping for short amounts of time and breathing issues while sleeping.

Too little sleep has officially been linked to an increased risk of obesity, particularly among young children. Recent findings published in The Journal of Pediatrics reveals a high connection between sleep-related breathing problems and obesity.

For the study, researchers analyzed data from 1,900 children in England and followed the participants for about 15 years. Study results showed that those who got the least amount of sleep between the ages 5 and 6 had between a 60 percent and 100 percent increased risk of obesity by age 15.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," said lead study author Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women's health at Einstein, in a news release. "Sleep-disordered breathing, or SDB, which includes snoring and sleep apnea, is also a risk factor for obesity but receives less attention. These two risk factors had not been tracked together in children over time to determine their potential for independently influencing weight gain. Our study aimed to fill in that gap."

Furthermore, researchers found that children with the most severe sleep-disorder breathing (SDB) had the highest obesity risk. Children whose SDB levels peaked at around 5 to 6 years old still had a 60 to 80 percent increased risk of obesity, but fared better overall.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is oftentimes due to enlarged tonsils or adenoids, which can be removed with surgery if a problem occurs. Misalignment of jaws or teeth can also cause issues.

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Study: Older women with sleep disordered breathing find it harder to perform activities

A study shows that older women who have sleep disordered breathing find it harder to perform daily activities.

Older women with disordered breathing during sleep were found to be at greater risk of decline in the ability to perform daily activities, such as grocery shopping and meal preparation, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco.

The study was published Nov. 6 in the online edition of the Journal of the American Geriatrics Society.

The findings are notable given the aging of the population -- an estimated 3.7 million Americans will turn 65 in 2015, and by 2030, 19 percent of the U.S. population will be 65 or older -- and the fact that sleep-disordered breathing is treatable. Older adults are as much as four times as likely as middle-aged individuals to have problems with breathing during sleep.

Sleep-disordered breathing involves repeated interruptions or decreases in breathing during sleep, which often leads to fragmented sleep and hypoxemia, or low blood oxygen levels. Doctors rate the severity of sleep-disordered breathing with the apnea-hypopnea index (AHI), which reflects the number of breathing interruptions (apneas) and the number of significant decreases in breathing (hypopneas) per hour of sleep.

The study found that women with an AHI on the moderate to severe side, with 15 or more breathing disruptions per hour of sleep, had a 2.2 times greater odds of decline in daily activity functions during the evaluation period, which averaged five years between baseline evaluation and follow-up.

"Because sleep-disordered breathing can be treated effectively, it is possible that treatment could help prevent decline in important areas of functioning that allow older adults to remain independent," says Adam Spira, PhD, an associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health and the study's lead author. "As is often the case, more research is needed to investigate this possibility."

Because the study was observational, the researchers can't conclusively state that sleep-disordered breathing caused the functional decline, but the research does point to a strong link.

Earlier studies involving older men have linked sleep-disordered breathing with frailty and death. The authors believe this is one of the first studies to assess the impact of sleep-disordered breathing on decline in older women's ability to perform basic functions associated with independent living.

The study included 302 women, with a mean age of 82.3 years. At the start of the study, participants underwent an in-home sleep evaluation. They were also asked whether they had any difficulty performing daily activities, including heavy housework, shopping and preparing meals, or any challenges with mobility, such as walking several blocks or climbing or descending stairs. Participants' self-reported daily activities and mobility were assessed once again in a follow-up evaluation.

The researchers say they believe it is the low blood-oxygen levels caused by sleep-disordered breathing that cause the trouble with daily tasks, and not sleep fragmentation, which is also increased by sleep-disordered breathing.

The authors note that women who reported no difficulties with daily activities during their baseline evaluation but a moderate-to-high AHI had a somewhat higher risk of reporting deterioration in daily-activity function in the follow-up evaluation. No links between sleep-disordered breathing severity and decline in mobility were observed.

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Study: Sleep disordered breathing can change pregnancy outcomes

According to a study, sleep disordered breathing during pregnancy can influence pregnancy outcomes, such as gestational diabetes.

Humans spend around 30 percent of their lives sleeping. Unfortunately, this time to re-energize and recharge our batteries may not always be so "restful" for everyone. Now, a recent study published in the American Journal of Obstetrics & Gynecology found that women dealing with this health issue may endure more problems throughout their pregnancy.

For the study, researchers examined 188 women and assessed the prevalence and trend of sleep-disorder breathing (SDB) and its effect on pregnancy outcomes.

Researchers discovered a dose-dependent relationship between the severity of SDB throughout early pregnancy and the risk of developing gestational diabetes. They also found that those with more moderate or severe SDB throughout early pregnancy were at an increased risk of developing gestational diabetes.

"This study suggests a dose-dependent relationship between SDB exposure in early pregnancy and the subsequent development of gestational diabetes," the authors noted in the study. 

However, researchers note that there was no association between SDB exposure in early or late pregnancy, as well as any of the other adverse pregnancy outcomes.

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Fibromyalgia may be a sleep disorder

A neurologist can detect alpha intrusion on a sleep study. JR

A study claims that fibromyalgia syndrome may be a sleep disorder, or at least linked to one.

Nobody says, "I don't believe hypertension exists," or "I don't believe 'stroke' is a real thing." People with fibromyalgia syndrome (FMS) suffer not only from constant widespread pain, but they also sometimes face judgment and distrust from medical professionals who doubt if their condition is real. They are labeled as annoying and needy. In the literal sense, insult is added to injury.

The root cause of FMS is poorly understood, which may explain why its legitimacy is questioned by some healthcare professionals. FMS is characterized by chronic widespread musculoskeletal pain, stiffness, and tenderness at multiple points. The prevalence of FMS ranges from 2 percent to 3 percent of the general population, with women affected six to nine times more frequently than men.

In addition to pain symptoms from head to toe, people with FMS also complain of poor sleep, chronic fatigue, depressed mood, headaches, and many other symptoms. However, complaints of poor sleep and chronic fatigue may be more significant to individuals with FMS than pain symptoms. Analysis of slow-wave sleep in individuals with FMS often demonstrates characteristic alpha-wave intrusions in slow wave sleep, which are thought to contribute to poor sleep in this population. Furthermore, a trial using sodium oxybate, a medication known to increase slow-wave sleep, demonstrated improvement in fibromyalgia symptoms.

As the association between FMS and sleep has been further studied, more evidence has mounted that FMS in many cases is a byproduct of a sleep disorder. A 2006 study demonstrated a more than ten-fold increase in FMS in subjects with sleep-disordered breathing (SDB) compared to the normal population.

Research suggests that FMS is a disorder of hypersensitivity of the central nervous system (CNS). The peripheral nervous system (PNS) is constantly sending signals from various areas of the body to the CNS. The CNS then filters these signals, ignoring the insignificant while responding to the more pressing. Due to the hypersensitivity of the CNS in FMS, those lesser signals are not filtered, leading to widespread pain.

Poor sleep quality has a similar effect on CNS signal filtration. Many with chronic pain syndromes (e.g., arthritis) describe improvement in pain with a good night's sleep and vice versa. It is a well-known phenomenon in the neurology community that sleep deprivation is a powerful trigger for seizures. Seizures are caused by inappropriate hyperexcitation of certain neurons leading to a cascade of electrical discharges in the cerebral cortex that overcome (or "seize") the function of that region of the brain.

Diagnosis and treatment of SDB and other chronic sleep conditions can lead to significant improvement in FMS independent of any other therapy. However, since the overwhelming majority of FMS sufferers are women, and many women with SDB have more subtle airflow disruptions than their male counterparts, it is essential that testing be sensitive enough to detect these less obvious changes. Those who have had a prior negative sleep study or who do not snore should seek a sleep center that focuses on diagnosing and treating subtle SDB, such as Upper Airway Resistance Syndrome. Esophageal manometry can be used to measure intrathoracic pressure during sleep. This metric can help detect increased respiratory effort and subtle changes in airflow during sleep that can cause sleep fragmentation and that otherwise would be missed.

FMS sufferers with poor sleep may experience frequent nighttime arousals, tossing and turning in bed, morning headaches, nasal congestion in the morning that was not present upon going to bed, dry mouth during the night, episodes of waking up with palpitations, teeth clenching or grinding at night, temperomandibular joint (TMJ) or jaw pain in the morning, and acid reflux during the night or in the morning. While these are not specific signs independently, they all are suggestive of irregular breathing during sleep.

So for the four to six million Americans suffering from FMS, perhaps it's time to see a sleep specialist. A proper night's sleep just might cure what ails you.

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Sleep disorders in children may be caused by winter viruses

Sleep disorders in children related to breathing during sleep may be due to winter viruses.

A good night's sleep is important to our children's development. But with the first day of school just passed, many children are at increased risk for sleep breathing disorders that can impair their mental and physical development and hurt their academic performance.

A study conducted in North America in 2011 showed that the frequency of sleep-disordered breathing increases in the winter and spring. Until now, researchers believed asthma, allergies and viral respiratory infections like the flu contributed to disorders that affect children's breathing during sleep.

Now, in a new study conducted at the Pediatric Sleep Center at the Tel Aviv Sourasky Medical Center and published in the journal Sleep Medicine, Riva Tauman and her fellow researchers of the Sackler Faculty of Medicine at Tel Aviv Univ. have shown that asthma and allergies do not contribute to pediatric sleep-disordered breathing. Viruses alone, they say, may be responsible for the seasonal variation seen in children.

The researchers say the study has broad implications for the treatment of sleep-breathing disorders in children, bolstering the idea that the time of year is relevant when treating children for sleep-disordered breathing in borderline cases.

Blowing hot and cold

"We knew from research and clinical practice that sleep-disordered breathing in children gets worse during the colder months," Tauman says. "What we didn't expect is that the trend has nothing to do with asthma or allergies."

"Sleep-disordered breathing" is a blanket term for a group of disorders. One of the common disorders is obstructive sleep apnea, in which the upper airway becomes blocked, usually by enlarged tonsils or adenoids, causing snoring and, in more severe cases, breathing pauses that lead to poor-quality and fragmented sleep and decreased oxygen and elevated carbon dioxide levels in the bloodstream.

In the long term, sleep-disordered breathing in children can cause stunted growth, heart disease and neurocognitive problems associated with diminished school performance, impaired language development and behavioral issues.

In their study, Tauman and her Sackler Faculty of Medicine colleagues Michal Greenfeld and Yakov Sivan statistically analyzed the cases of more than 2,000 children and adolescents who were referred to the sleep center to be tested for suspected sleep-disordered breathing between 2008 and 2010. Confirming earlier results of a 2011 study of five- to nine-year-olds, the researchers found that pediatric sleep-disordered breathing is worse in the winter — which in Israel they defined as from November to March — than in the summer. The seasonal variability is most apparent in children less than five years old, they found.

The researchers also found that wheezing and asthma do not contribute to the trend.

Based on their findings, the researchers speculate that viral respiratory infections — which are more prevalent in younger children and during colder months — are the major contributor to the seasonal variability seen in pediatric sleep-disordered breathing.

Taking the long view

If the sleep clinic tests had all been conducted in the winter, the researchers estimate that seven percent more children would have been diagnosed with sleep-disordered breathing. Seven percent fewer would have been diagnosed if all the tests had been done in the summer, they estimate.

"Our study suggests that if a child comes into the sleep laboratory in the winter with a mild case, I may consider not treating him. I can assume he will be better in the summer," says Tauman. "But if he has only mild symptoms in the summer, I can assume they are more severe in the winter."

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Bedtimes help with obstructive sleep apnea

This article discusses obstructive sleep apnea and how adhering to a consistent bedtime helps with sleep apnea treatment.

Obstructive sleep apnea (OSA) occurs when the upper airway collapses during sleep. It is the most common type of sleep-disordered breathing, and chances of it occurring are greater in obese people. OSA is the second most prevalent sleep disorder among adults.

The first line of treatment for sleep apnea is a noninvasive, in-home treatment called CPAP -- continuous positive airway pressure therapy. However, if patients do not use the treatment consistently for the majority of sleep hours each night, it cannot help.

"It has been shown that routine is important for adherence when it comes to medication, and routine is also relevant to CPAP adherence," said Amy M. Sawyer, assistant professor ofnursing, who will report her results at SLEEP 2013, the annual meeting of the Associated Professional Sleep Societies, in Baltimore on June 5.

The researchers define CPAP adherence as using the treatment for at least four hours each night. They found that if a patient's bedtime was consistent within 45 minutes, they were significantly more likely to use the CPAP machine for at least four hours each night. A patient whose bedtime was inconsistent -- varying by an hour and five minutes or more -- was much less likely to adhere to treatment.

The researchers found that adults whose bedtime varied by more than 75 minutes or more per night, were 3.2 times more likely to use CPAP less than four hours per night after one month of treatment. For every 30-minute increase in bedtime variability, or inconsistency, the odds of nonadherence to CPAP treatment were 1.8 times greater.

Sawyer and her colleague Tonya King, professor of public health sciences, Penn State College of Medicine, are the first to study the consistency of bedtime and its correlation to treatment adherence.

The researchers asked 97 volunteers who were about to begin CPAP treatment to keep a sleep diary beginning seven days prior to starting treatment. The volunteers recorded the time they went to bed and the time they woke up each day for seven consecutive days.

Each CPAP machine had a microprocessor built in that sent CPAP-use information every 24 hours to the researchers. The microprocessor recorded the patient as using the CPAP machine when breathing through the CPAP mask was detected for longer than 20 minutes.

While the researchers found that regularity of bedtime before beginning CPAP use did not influence adherence during the first week of treatment, it did affect adherence for the first month.

"Unlike many other treatments, CPAP treatment adds new complexity to a person's daily routines," said Sawyer. She and King think that using CPAP is a learned behavior that needs to become a habit.

Sawyer indicated that next steps include figuring out ways to help patients incorporate CPAP use into their daily routine and also studying other consistencies or lack thereof in bedtime routine -- beyond what time a person goes to bed that may influence a person's ability to regularly use CPAP.

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Sleep Disorders and Night Terrors in Children

Children with parasomnias such as night terrors often have other sleep disorders as well.

Sleep disordered breathing, periodic limb movement, and mood disturbances are common comorbidities in pediatric patients with parasomnias, researchers reported here.

Among children with parasomnia, roughly half surveyed reported snoring, mood disturbances, or demonstrated signs of obstructive sleep apnea on a pediatric sleep questionnaire, according to Arveity Setty, MD, of Cincinnati Children's Hospital in Ohio, and colleagues.

Other common co-conditions with pediatric parasomnia included breathing pauses, frequent leg movements, insomnia, and adverse effects that occurred during waking hours, Setty noted at a poster presentation at the Associated Professional Sleep Societies meeting.

Prior research has shown that sleep disordered breathing can trigger parasomnias and that treating sleep apnea can also resolve parasomnias. Parasomnias, such as night terrors, are common in pediatric populations.

Other research has also shown associations between epilepsy and parasomnias, night waking, sleep duration, and daytime sleepiness in pediatric populations.

The authors studied sleep complaints and coexisting sleep disorders through a survey of 145 pediatric patients, ages 1 to 20, with parasomnia through survey and overnight sleep study at a single center. Participants had a mean age of 11.3.

Patient's sleep complaints and daytime symptoms were recorded, as were data from the overnight sleep study, to compile frequency of various co-occurring symptoms with patients' parasomnias. Coexisting disorders were validated through polysomnography.

Nearly half of the patients in the study had symptoms of snoring (48.3%), insomnia (41.4%), mood disturbances (41.4%), and had Michigan Pediatric Sleep Questionnaire scores indicating obstructive sleep apnea (40.7%).

Roughly one-third of study participants reported breathing pauses while sleeping (35.2%) and received a diagnosis of obstructive sleep apnea following the overnight sleep study (31%).

Frequent leg movements were reported by 22.1% of participants and confirmed periodic limb movement disorder in 17.9% of patients following the sleep study.

In addition to mood disturbance, other daytime adverse events included daytime headache in 7.6% of patients, daytime sleepiness in 22.1% of patients, and, following scoring though the Epworth sleepiness scale, significant excessive daytime sleepiness in 15.9% of patients.

Participants who participated in long-term follow-up and received treatment for obstructive sleep apnea and periodic limb movement disorder showed improvement in parasomnia.

"Parasomnia in children is associated with significant daytime consequences, including daytime headaches, excessive daytime sleepiness, and mood disturbances," as well as coexisting disorders such as sleep apnea and periodic limb movement disorder, Setty concluded.

Setty added that follow-up studies should determine whether the daytime symptoms are the result of the parasomnia or the associated and coexisting sleep disorders.

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Sleep Apnea in Children leads to Learning Complications

Obstructive sleep apnea in children leads to learning complications such as ADHD, behavioral problems, or learning problems.

New research confirms the relationship between obstructive sleep apnea in children and ADHD, as well as other behavioral and cognitive problems. Children with sleep apnea, a common type of disordered breathing during sleep, are more likely to have difficulties with learning and attention.

Obstructive sleep apnea, a type of sleep-disordered breathing (SDB), affects about 2 percent of children in the United States, according to the American Academy of Sleep Medicine. The link between obstructive sleep apnea in children and ADHD (attention-deficit hyperactivity disorder) has been previously established, but this is the first sleep study to use self-reports in assessing children's adaptive behavior, or ability to adapt to new situations.

The study, published in the April edition of the journal SLEEP, analyzed sleep and cognitive data from 263 Arizona children enrolled in the Tucson Children's Assessment of Sleep Apnea Study (TuCASA) over five years. The children, all between 6 and 11 years old, completed overnight sleep studies and standard series of neurobehavioral tests at the beginning and end of the 5-year period. Their parents also answered questionnaires about the children's behavior.

The sleep studies divided the children into four groups: those who never had sleep-disordered breathing, those who had it the first time but not the second, those who had it only the second time (new onset), and those who had it both times (persistent).

The results showed that children with new onset sleep apnea were at least four times as likely to have behavioral problems- the likelihood rose to six times higher if they had persistent sleep apnea.

The children with obstructive sleep apnea were more likely to have parents reporting problems with their hyperactivity, attention, communication abilities, self-care, and ability to adapt to new situations. They were also likely to be suffering academically, with grades of C or lower in school.

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB," said Dr. Michelle Perfect, the study's lead author and assistant professor in psychology at the University of Arizona in Tucson.

Obstructive sleep apnea is a major cause of snoring, occurring when soft tissue in the back of the throat relaxes too much during sleep and collapses into the airway. This cuts off oxygen intake, and the temporary suffocation sends a signal to the brain to wake up immediately. When sleep apnea is especially severe, it can interrupt sleep hundreds of times throughout the night- depriving the brain of oxygen and causing exhaustion the next day.

Children with sleep-disordered breathing generally have larger tonsils and adenoids than other children their age, and most children with sleep apnea have a history of loud snoring. Effective treatment options for children include the surgical removal of the tonsils and adenoids or the use of continuous positive airway pressure (CPAP) therapy.

The Arizona researchers say in their study that most children with sleep apnea have larger tonsils and adenoids than those without it, and are much more likely to snore loudly. Tonsillectomies can provide effective sleep apnea treatment, and so can continuous positive airway pressure (CPAP therapy).

Perfect said in a statement that obstructive sleep apnea in children typically declines into adolescence, but that "taking a wait and see approach is risky" for parents who are worried about their children's cognitive and behavioral development.

"School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom."

The New York Times suggests that ADHD-related learning problems may often result from obstructive sleep apnea in children, and that the symptoms could be better treated with sleep improvements than with stimulant medications like Adderall and Ritalin, which can actually increase sleep deprivation.

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Higher risk of behavioral issues in children with sleep apnea

This article discusses how children with obstructive sleep apnea have more behavioral issues that can present as ADHD-type symptoms.

A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioral problems in children as well as other adaptive and learning problems.

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB," said Michelle Perfect, PhD, the study's lead author and assistant professor in the school psychology program in the department of disability and psychoeducational studies at the University of Arizona in Tucson. "School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom."

The five-year study, which appears in the April issue of the journalSLEEP, utilized data from a longitudinal cohort, the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). The TuCASA study prospectively examined Hispanic and Caucasian children between 6 and 11 years of age to determine the prevalence and incidence of SDB and its effects on neurobehavioral functioning. The study involved 263 children who completed an overnight sleep study and a neurobehavioral battery of assessments that included parent and youth reported rating scales.

Results show that 23 children had incident sleep apnea that developed during the study period, and 21 children had persistent sleep apnea throughout the entire study. Another 41 children who initially had sleep apnea no longer had breathing problems during sleep at the five-year follow-up.

The odds of having behavioral problems were four to five times higher in children with incident sleep apnea and six times higher in children who had persistent sleep apnea. Compared to youth who never had SDB, children with sleep apnea were more likely to have parent-reported problems in the areas of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care. Children with persistent sleep apnea also were seven times more likely to have parent-reported learning problems and three times more likely to have school grades of C or lower.

The authors report that this is the first sleep-related study to use a standardized questionnaire to assess adaptive functioning in typically developing youth with and without SDB.

"Even though SDB appears to decline into adolescence, taking a wait and see approach is risky and families and clinicians alike should identify potential treatments," said Perfect.

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Sleep Disordered Breathing in Children and its Risks

This article discusses signs of sleep disordered breathing in children, its prevalence and other statistics on sleep disordered breathing, and the risks it poses to the child's health.

Does your child snore? Does he breathe through his mouth when he sleeps? Do you ever notice pauses in your child's breathing while she's asleep? If you've answered yes to any of these questions, your child may be suffering from sleep-disordered breathing.

Sleep-disordered breathing in children is disruptive to their nightly rest, which can result in other health problems. Scientists are still working to get a sense of how prevalent the disorder is among children. We're also still learning about the risk factors that contribute to sleep-disordered breathing in children, as well as the health consequences for kids who suffer from it. Increasingly, it appears that both the risks and the health effects of sleep-disordered breathing are different in children than they are in adults. A new study examines both the prevalence of sleep disordered breathing in children, and the particular risk factors they face.

Researchers in Finland examined sleep-disordered breathing in 491 children ages 6-8. Their study, which was part of a larger research project on child health, analyzed the prevalence of sleep-disordered breathing among the children. The study also examined risk factors that might contribute to the sleep disorder, including tonsil size, jaw position and facial proportions. For the purpose of this study, sleep-disordered breathing was defined as frequent or loud snoring, mouth breathing during sleep and sleep apnea.

Here are some important highlights of their results:

• 9.9% of children had some type of sleep-disordered breathing. This rate was the same for both boys and girls in the study
• Average body-fat percentage was 20.6 for girls and 15.0 for boys
• 11.4% of boys and 15.6% of girls were overweight or obese
• Body fat was not associated with an increased risk of sleep-disordered breathing. Sleep-disordered breathing was no more frequent among obese and overweight children in this study than among children at normal weight

Several craniofacial features were associated with elevated risk for sleep-disordered breathing: 

• Children with enlarged tonsils were 3.7 times as likely to experience symptoms of sleep-disordered breathing


• Children with cross bite were 3.3 times a likely to have sleep-disordered breathing. Cross bite is a dental condition where teeth are out of alignment with corresponding teeth above or below.


• Children with convex facial profiles were 2.6 times as likely to suffer from sleep-disordered breathing as children with other facial types. Convex facial features include prominent forehead and brow line and receding chin.

These results suggest that the risk factors for sleep-disordered breathing in children may be very different than those for adults. The most significant risk factor of sleep-disordered breathing in adults is excess body weight. Research indicates that 70% of people who are morbidly obese have obstructive sleep apnea. This study indicates that excess weight may not be a risk factor for children. For them, features of the head, neck and throat, as well as certain dental conditions, may be more significant indicators of risk for sleep-disordered breathing.

The health problems for children who develop sleep-disordered breathing also appear to be different than those for adults. A growing body of research indicates that children who experience sleep-disordered breathing are at greater risk for problems with behavioral, emotional and cognitive development: 

• This large-scale study of more than 11,000 children found that kids with sleep-disordered breathing were significantly more likely to exhibit behavioral and emotional problems, including hyperactivity, anxiety, depression, social issues with peers, and conduct problems including aggressiveness.


• Children who exhibit aggressive and bullying behavior in school were twice as likely to have some form of sleep-disordered breathing, according to this research


• Children with sleep-disordered breathing demonstrated lower intellectual abilities than those without, in this study. This cognitive impairment existed regardless of the degree of severity of the sleep disorder. Even children with mild forms of sleep-disordered breathing experienced cognitive difficulties.

A recent large-scale study in the United States examined the prevalence for sleep disordered breathing among children. Researchers evaluated more than 12,000 children between the ages 6 months and 6.75 years, and found: 

• 1-2% of children across all ages suffer from chronic sleep apnea


• As many as 21% of children in this age range snore habitually


• Children ages 1.5-2.5 years are especially vulnerable to snoring: researchers found a significant increase in rates of snoring among children at this age


• By the age of six, 25% of children are mouth breathing during sleep

These latest results from Finnish scientists add to the body of research that indicates how significant an issue sleep-disordered breathing is for children. We need to know more about the prevalence of the disorder among children, as well as the risk factors and health consequences. We also need to further explore how the risks to children may differ from adults.

To avoid the behavioral, cognitive and emotional problems associated with sleep-disordered breathing, we also need to get better at identifying the problem. Early intervention can help avoid more serious problems that can occur if the disorder is left untreated. The most effective treatment strategy will involve the cooperation among doctors and dentists. But the process starts with parents. Paying attention to your child's breathing during sleep, and bringing attention to any signs of irregular breathing, is the first and critical step.

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Study: Sleep problems in young children tied to special ed need

A new study claims sleep issues in young children may be linked to special education needs.

(HealthDay)—A history of either sleep-disordered breathing (SDB) or behavioral sleep problems (BSPs) through the age of 5 years is associated with an increased likelihood of special educational need (SEN) at 8 years of age, according to a study published online Sept. 3 in Pediatrics.

To examine the association between SDB, BSP, and SEN, Karen Bonuck, Ph.D., from the Albert Einstein College of Medicine in Bronx, N.Y., and colleagues analyzed more than 11,000 parental responses in the Avon Longitudinal Study of Parents and Children on children's snoring, witnessed apnea, and mouth-breathing at 6, 18, 30, 42, and 57 months. For 11,049 children, parent report of SEN at age 8 was available.

The researchers found that previous history of SDB and BSPs correlated significantly with SEN, after controlling for 16 putative confounders. For roughly each one-year interval at which a BSP was reported there was a 7 percent increased odds of SEN. SDB was associated with a near 40 percent increased odds of SEN. SEN was 60 percent more likely in children in the worst symptom cluster.

"Findings presented here strongly support an association between early childhood sleep problems and later SEN, on a population basis," the authors write. "This highlights the need for early screening, because early treatment is often effective for SDB and BSPs." More information: Abstract

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Children's Sleep Problems Signal Later Emotional Troubles

A milestone in child development, at least for many parents, is when the kid finally sleeps through the night. But a recent study suggests that it’s a good idea for parents to monitor how the wee ones are sleeping as well as how long.

Published in the journal Pediatrics, the study shows that children who have problems breathing while they sleep are more likely to experience behavioral problems such as hyperactivity and aggressiveness when they get older. They’re also more likely to have emotional issues such as difficult peer relationships.

Researchers from the University of Michigan and the Albert Einstein College of Medicine at Yeshiva University followed the sleeping patterns of more than 11,000 children for six years. They found that kids who snored, breathed heavily through their mouths and experienced apnea—long pauses between breaths during sleep—were at risk.

Collectively known as sleep-disordered breathing (SDB), the problem peaks when children are between 2 and 6 years old, but can occur when they are younger. Approximately 1 in 10 children snores regularly and 2 to 4 in 100 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, but be wary of the “quick-fix” of tonsillectomy—as we have reported, that surgical procedure is often unnecessary, and to conclude that tonsils contribute to sleep disorders requires careful diagnosis.

Quite simply, the study’s authors said, “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.”

Although earlier studies indicated sleep problems could signal later difficulties, they involved only small numbers of patients, short follow-up of a single symptom or limited control of individual traits such as low birth weight that could be responsible for some symptoms.

In the new, more substantial study, children whose symptoms peaked between the ages of six and 18 months were much more likely to experience behavioral problems when they were 7 compared with children who breathe normally during sleep. Children whose SDB symptoms persisted throughout the evaluation period, and were most severe at 30 months, expressed the most severe behavioral problems.

Researchers theorize that SDB might be responsible for behavioral problems because of its effect on the brain. Decreased oxygen levels and increased carbon dioxide interrupts the restorative process of sleep and disrupts various chemical systems. Such malfunctions can impair one’s ability to pay attention, plan ahead and organize. They also impede one’s ability to regulate emotions.

To learn more about SDB and treatment options, consult the AAO-HNS fact sheet.

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Snoring and Sleep Apnea can Lead to Behavioral Problems

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".

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".

Read more: http://www.webmd.boots.com/sleep-disorders/news/20120305/childrens-snoring-linked-to-behavioural-problems