Sleep apnea surgery in children helps improve asthma control

Removing a child's tonsils and adenoids for sleep apnea can help his or her asthma control.

Researchers from the University of Chicago found that surgical removal of the tonsils and adenoids in children suffering from sleep apnea is associated with decreased asthma severity. The study was published in PLOS Medicine (November 4, 2014).

In the first year after the operation, the children who had their tonsils and adenoids removed had a 30% reduction in acute asthma exacerbations and a 38% decrease in acute status asthmaticus, episodes of severe asthma that do not respond to repeated courses of therapy.

"Several small studies have described a strong association between obstructive sleep apnea and asthma, two common inflammatory conditions that impair breathing in children. But we wanted to test the strength of the connection when studied in a much larger population," said lead study author Rakesh Bhattacharjee, MD, an assistant professor of pediatrics at the University of Chicago and an authority on pediatric sleep medicine, in a statement.

Obstructive sleep apnea is affects an estimated 2% to 3% of all children. The removal of the adenoids and tonsils, known as surgical adenotonsillectomy, is considered standard therapy.

Asthma is the third-most prevalent chronic pediatric disease in the U.S., affecting an estimated 7.1 million according to the Centers for Disease Control and Prevention and is the third-most common cause of hospitalization of U.S. children younger than age 15.

In the study, researchers also noted that pediatric patients who received the surgery had a 36% reduction in asthma-related hospitalizations and a 26% decline in asthma-related emergency room visits. Children who did not have the surgery did not have significant reductions in these categories.

"Our study adds weight to the growing sense that obstructive sleep apnea aggravates asthma and further tips the balance toward early identification of obstructive sleep apnea," Dr. Bhattacharjee said. "This will help physicians advocate for surgical intervention, not just to eradicate sleep-disordered breathing, but also to reduce asthma severity and decrease reliance on medications in asthmatic children."

Data on more than 40,000 children between the ages of 3 and 17, obtained from Truven Health's MarketScan databases were included in the study. More than 13,500 U.S. children with asthma who underwent removal of their adenoids and tonsils as treatment for obstructive sleep apnea were included. Asthma symptoms from the year before surgery to the year afterward were compared. Researchers also matched those results to the results of more than 27,000 children with asthma who still had their tonsils and adenoids.

Overall, adenotonsillectomy brought significant improvement: The frequency of acute status asthmaticus dropped almost 40%, from 562 in the year before surgery to 349 in the year after. In children who did not have surgery, such severe asthma attacks also decreased but by only 7%, from 837 to 778.

Acute asthma exacerbations fell from more than 2,200 before surgery to 1,566 after, a 30% reduction. Exacerbations for children who did not have surgery also fell from 3,403, to 3,336, a 2% drop.

Also decreasing significantly for those children who had the surgery was the incidence of secondary asthma outcomes, such as acute bronchospasm and wheezing, while rates were unchanged for those who did not. Prescription refills followed the same pattern.

The authors' concerns about the MarketScan database included that it only includes those patients with private insurance and a lack of available data why patients underwent adenotonsillectomy.

Despite the limitations, they emphasize the many plausible connections that link obstructive sleep apnea to asthma:

• Both are inflammatory diseases.
• Both share risk factors, such as allergies, obesity, and exposure to tobacco smoke.
• Severe obstructive sleep apnea is often associated with poorly controlled asthma.

A prospective, randomized, controlled clinical trial is still needed to show a direct causal relationship, Dr. Bhattacharjee noted.

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Snoring in Children

This article discusses what is important to know about snoring in children.

Snoring in children is a common event, with estimates placing it at about 12 to 15 percent. Most of these children are healthy, show no symptoms and have primary snoring. Snoring happens during sleep due to a blockage of air when breathing as it passes through the back of the mouth. The loudness is affected by how much air passes through and how fast the throat tissue is vibrating. Snoring can be due to an upper respiratory infection, allergies, or it can be a sign of obstructive sleep apnea (OSA).

Infants and toddlers spend over half of their lives sleeping and, by adolescence, greater than on third of our lives are spent sleeping. Quality sleep is essential for proper development and daily functioning. Proper sleep helps with learning, consolidating memories, physical growth, recharging the body and helping our bodies fight infections.

Approximately 2 to 3 percent of children have OSA, which occurs when the posterior air collapses and blocks the throat. Frequent pauses in breathing, lasting from several seconds to a minute, often lead to the brain briefly waking up and causing us to breathe. This leads to gasping or snorting, waking us up and re-breathing. This can occur all through out the night.

Interrupted sleep can lead to behavioral issues, problems with social function, poor school performance and poor growth. These children are also more likely to be hyperactive and have trouble paying attention in school, mimicking signs of attention-deficit hyperactivity disorder (ADHD).

Studies also show that children with OSA are at risk of developing heart and lung problems which can lead to serious consequences later in life if it goes undetected. Untreated OSA, in the short term, often leads to daytime sleepiness, morning headaches, irritability, bed wetting and mouth breathing. The risk of apnea is higher in overweight children.

Other signs might include large tonsils and/or adenoids with frequent mouth breathing, restless sleep or sleep in abnormal positions, sleep in elevated position or with neck extended, excessive sweating during sleep, nasal speech, poor weight gain or being overweight, and high blood pressure. Even primary snoring (i.e. snoring without breathing pauses, frequent arousals, or drips in oxygen levels), which was once thought to be normal, still can lead to problems in school performance or behavior issues.

If you suspect your child may have symptoms of OSA don’t assume his or her snoring will go away on its own. Talk to your child’s doctor. The American Academy of Pediatrics has recognized this as a serious problem and has published recent guidelines for screening of obstructive sleep apnea, which will help doctors recognize, diagnose, and treat children with OSA.

Testing can be done if your child is suspected of having OSA, including an overnight sleep study. You may also videotape your child’s sleep to bring to the doctor for review. Night-time pulse oximetry to measure oxygen levels is also a useful tool. Your doctor may refer your child to a sleep specialist as well, as sometimes these tests are normal even when your child may still have OSA.

Once your child has been found to have obstructive sleep apnea syndrome, referral to doctors who specialize in treating OSA include pediatric otolaryngologists (ENT), pulmonologists and neurologists. Treatment options usually include removing enlarged tonsils and adenoids (T&A). Often removing the tonsils and adenoids stops the snoring and helps with improved appetite and growth in young children. It also improves academic performance and behavior in school-aged children as they get more uninterrupted, quality sleep. Other options include treating allergies or helping children lose weight. A night-time treatment called continuous positive airway pressure (CPAP) therapy is another option for children who can’t have surgery or have persistent OSA even after a T&A has been performed.

Remember to be suspicious that your child may have OSA if he or she regularly snores and has apnea, daytime sleepiness or school/behavior problems. If detected early, treatment of this problem may be reversible.

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Sleep apnea symptoms persist after adenoid and tonsil removal in children

A study claims that children with severe obstructive sleep apnea saw residual sleep apnea symptoms following an adenotonsillectomy procedure.

Children with severe obstructive sleep apnea before adenotonsillectomy were more likely to experience residual symptoms after surgery, according to findings in a retrospective study.

Researchers evaluated data from 283 children younger than 3 years (mean age, 22 months). Each child underwent a preoperative polysomnogram between 2002 and 2010.

Of the study population, 61.8% were boys and 84.8% were black. According to their BMI, 46.7% of the children were obese, whereas 33.1% were classified as having a healthy weight. At baseline, 65.7% of the children had a severe apnea hypopnea index (>10).

Seventy of the children also underwent a post-adenotonsillectomypolysomnogram after a mean time of 7.7 months. Compared with the children who only underwent a preoperative polysomnogram, those who had preoperative and postoperative polysomnograms were younger (23 vs. 20 months; P=.002), shorter (81 cm vs. 79 cm; P=.04) and weighed less (13 kg vs. 11 kg; P=.01). They were also more likely to have had a severe index before surgery (22 vs. 35; P=.002) and lower mean minimal oxygen saturations (83% vs. 77%; P<.001).

Fifteen of the 70 children had residual obstructive sleep apnea (index, >5) and a significantly higher preoperative index (P=.02) compared with those without residual symptoms. However, these 15 children had a mean apnea hypopnea index that dropped from 55 to 21 (P=.03), whereas mean minimum oxygen saturations increased from 74% to 82% (P=.09) after surgery.

“Our data support the finding that, although [adenotonsillectomy] leads to a dramatic improvement in this age group, a high proportion of this population will have residual [obstructive sleep apnea],” the researchers wrote. “Although this proportion gives some insight into residual disease after [adenotonsillectomy] in this young population, the result is flawed because of the retrospective design of the study and the fact that only 25% of the children treated received postoperative [polysomnogram].”

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Ways to get children to sleep more

This article discusses why children may not be sleeping much and how to get them to sleep more.

Asking sleep experts for advice on how to put children to bed often feels like an exercise in futility. The standard tips are banal and predictable: avoid caffeine; remove the TV from their bedroom; don’t sleep on a full stomach; put up dark blinds. You have the feeling the experts are holding out on us—there has to be something more. And there is. Here’s the stuff they’d love to tell you, if they weren’t afraid of overwhelming you with science.

• Ever wonder why most people sleep better when their bedrooms are cool? It’s because the circadian rhythm system that helps regulate sleep cycles is not just light sensitive, it’s temperature sensitive. Anything above a neutral air temperature both slows the body’s initiation of sleep and changes sleep patterns—a hotter room means an increase in non-REM sleep.

• 77 percent of children use television as part of their pre-bedtime routine. Sitting still and vegging out for half an hour should, theoretically, help a child unwind, as long as they’re not watching a show that excites them too much. However, the brightness of the screen undermines the theory. The light from a television or computer can delay both the necessary drop in core body temperature and melatonin production—and thus delaying sleep onset—by two hours.

• We’re all familiar with the agony of being super exhausted, yet not being able to fall asleep for hours. What gives? It’s because after just a few days of shortened sleep, the brain starts making extra stress hormone cortisol. It takes six times as long for this stress hormone to drop to a low-enough level that sleep is possible.

• In one study of 170 children, those in white-collar families tended to be in bed later and get up earlier than those in working-class families. Yet they actually got more actual sleep. How is that possible? It’s because their bedtimes and wake-times were more consistent; they stuck to their routine. This made their sleep more efficient—they rolled around in bed far less.

• Inconsistent bedtimes are, for all practical purposes, homemade jet lag—the desynchronization of the two systems that regulate sleep, the circadian rhythm and the homeostatic pressure system. Staying up three hours later on weekends is equivalent to flying across three time zones every weekend.

• With children averaging three hours of television per day, it’s hard to make the case children are universally overscheduled. But the most driven children are the most overscheduled—and the most sleep deprived. In some ways, these busy overachievers are those who concern the experts the most. According to University of Minnesota’s Dr. Kyla Wahlstrom, a motivated student can sacrifice sleep to maintain high GPAs, but she may pay for that success with higher levels of depression and stress. Teen boys who have a high number of extracurriculars are significantly more likely to be involved in a fall-asleep car crash. And those with part-time jobs both sleep less and have lower grades.

• For the majority of kids, rather than thinking it’s a choice between sleep and activities, the opposite is true: Students who sleep more are involved in more afterschool activities—with no detriment to their grades. They have the energy to be involved. Schools that have delayed start times have seen their students sleep more and increase their participation in sports and extracurriculars.

• Naps are not quite the salve we imagine. They appease the homeostatic pressure system, but not the circadian. You wake up feeling better—a two-hour nap is equivalent to 150 mg of caffeine—but naps do nothing to repair diminished cognitive functioning. The intellect is just as dulled after the nap as before. Kindergartners who take long naps, for instance, do worse on puzzle-solving.

• 16 percent of kids snore a few times a week. As recently as 2002, the American Academy of Pediatrics opined that children’s snoring was a benign condition not warranting treatment. Just five years later, researchers now caution that kids’ snoring is not like adult snoring at all—even a little snoring is a major cause for concern, because their developing brains can be deprived of oxygen.

• Common sleep disorders such as nightmares, restless leg syndrome, and frequent night waking can have a startlingly negative impact on children’s development—from using drugs at 14 to having clinical-level anxiety as adults. Research by University of Michigan’s Dr. Ronald Chervin indicates as many as 25 percent of kids diagnosed with ADHD have an underlying sleep disorder causing their symptoms. If treated for their sleep disorder, the ADHD would magically disappear. Despite the risks posed by sleep disturbance, the number of children treated for them is “vanishingly small.” Parents should consult a qualified sleep specialist—few pediatricians have expertise with sleep problems. Waiting to see if a child grows out of a sleep problem isn’t the answer.

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News about use of codeine after adenotonsillectomy. JR

Post-Surgery Codeine Puts Kids at Risk

Children are often prescribed codeine for pain relief after surgery to remove their tonsils or adenoids to treat chronic tonsillitis or sleep apnea, a condition in which breathing problems make it hard for them to sleep soundly.

However, some children have died after being given codeine in amounts that are within the recommended dose range.

The Food and Drug Administration (FDA) is taking steps to warn about the use of codeine to relieve children's pain after surgery to remove their tonsils or adenoids.

In August 2012, FDA warned the public that this danger exists for children who are "ultra-rapid metabolizers" of codeine, meaning that their liver converts codeine to morphine in higher than normal amounts.

Since then, FDA has conducted a comprehensive safety review of codeine use in children. A search of FDA's Adverse Event Reporting System (AERS) database from 1969 to May 1, 2012 identified 10 deaths and three overdoses associated with codeine. Many of these children were recovering from a surgery to remove their tonsils or adenoids.

A new boxed warning—FDA's strongest warning—will be added to the drug label of codeine-containing products about the risk of codeine to manage pain in children after a tonsillectomy and/or adenoidectomy. (The drug label is the written material that accompanies a prescription medication.)

FDA strongly recommends against the use of codeine to manage pain in children after a tonsillectomy and/or adenoidectomy. The agency asks health care professionals to use an alternate pain reliever.

In addition, parents and caregivers need to be aware of the risks of codeine treatment after tonsillectomy or adenoidectomy and should ask for a different pain medicine if their child is prescribed codeine in that setting

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The Problem 

Codeine is an opioid pain reliever—a narcotic medication—used to treat mild to moderate pain. It is also used to reduce coughing, usually in combination with other medications. Codeine is available by prescription either alone or in combination with acetaminophen or aspirin, and in some cough and cold medications.

Codeine is converted to morphine in the liver by an enzyme. Some people have genetic variations that make this enzyme over-active, causing codeine to be converted to morphine faster and more completely than in other people. These ultra-rapid metabolizers are more likely to have higher than normal amounts of morphine in their blood after taking codeine. High levels of morphine can result in breathing difficulty, which may be fatal.

From one to seven in every 100 people are ultra-rapid metabolizers, but they are more common among some ethnic groups. Twenty-nine percent of North African and Ethiopian populations are ultra-rapid metabolizers, and about 6 percent of African American, Caucasian and Greek populations are also affected.

The only way to know if someone is an ultra-rapid metabolizer is to do a genetic test. There are FDA-cleared tests to check for ultra-rapid metabolism.

The cases occurred in children who showed evidence of being ultra-rapid metabolizers. The children ranged in age from 21 months to 9 years old. All of the children received doses of codeine that were within the typical dose range, meaning that they were not given extra amounts of the medication.

In these cases, the signs of morphine overdose developed within one to two days after the children started taking codeine.

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Signs of Trouble 

The new changes to the codeine label warn health professionals about the use of codeine after tonsillectomy and/or adenoidectormy. FDA says that codeine should only be prescribed to children with other types of pain if the benefits are expected to outweigh the risks.

The agency warns that when prescribed to treat pain, codeine should not be given on a schedule, but only when the child needs relief from pain. Children should never receive more than six doses in a day.

Parents and caregivers should watch children receiving codeine for pain closely for signs of morphine overdose. There are a number of symptoms to watch for, says Bob Rappaport, M.D., director of the Division of Anesthesia, Analgesia and Addiction Products (DAAAP) in FDA's Center for Drug Evaluation and Research. If your child shows these signs, stop giving the codeine and seek medical attention immediately by taking your child to the emergency room or calling 911:

• Unusual sleepiness, such as being difficult to wake up
• Disorientation or confusion
• Labored or noisy breathing, such as breathing shallowly with a "sighing" pattern of breathing or deep breaths separated by abnormally long pauses
• Blueness on the lips or around the mouth

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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Behavioral Problems in Children: Think Sleep Apnea

This article discusses different types of sleep-related breathing problems in children and other associated sleep issues.

Children with sleep-related breathing problems (such as snoring or apnea) frequently have concurrent behavioral sleep problems (such as waking repeatedly) -- and vice versa, according to research led by a scientist at Albert Einstein College of Medicine of Yeshiva University. However, children with one type of sleep problem are not routinely evaluated and treated for the other. The findings suggest that pediatricians and... pediatric ...sleep medicine specialists should work together whenever a sleep problem is suspected.

The study was published Dec. 4 in the online edition of Behavioral Sleep Medicine.

"Our findings should raise awareness among parents and physicians that if a child is sleeping poorly, they should delve deeper to see if there is an unrecognized respiratory-related sleep problem," said senior author Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women's health at Einstein. "The best way to make sure this happens is by taking an interdisciplinary approach to the care of these children."

According to Dr. Bonuck, little was known about the co-occurrence of behavioral sleep problems and sleep-disordered breathing (SDB). She and her colleagues carried out this study to find the prevalence and duration of behavioral sleep problems and of SDB -- and the rate at which they co-occur -- in a large, population-based sample of children (aged 18 months to nearly 5 years). The researchers analyzed data on more than 11,000 children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

In response to mailed questionnaires, parents reported their child's snoring and apnea at 18, 30, 42, and 57 months of age. For the same time intervals, parents were also asked whether their child refused to go to bed, and whether they regularly woke early, had difficulty sleeping, had nightmares, got up after being put to bed, woke in the night, or awakened after a few hours. Children with five or more of these behaviors simultaneously were considered to have a clinically significant behavioral sleep problem.

The prevalence of behavioral sleep problems over the 18 to 57-month age reporting period ranged from 15 to 27 percent with a peak at 30 months of age. Among children with behavioral sleep problems, 26 to 40 percent had habitual SDB, again peaking at 30 months. Among children who had habitual SDB, 25 to 37 percent also had a behavioral sleep problem, peaking at 30 months.

While it is unlikely that behavioral sleep problems cause SDB, the converse may be true, noted Dr. Bonuck. Frequent night wakings initially related to SDB may be reinforced by the parents' anxious responses. These behaviors may, in turn, develop into a persistent behavioral sleep problem, despite adequate treatment for SDB.

"It's important that we pay attention to how our children are sleeping," said Dr. Bonuck. "There's ample evidence that anything that interrupts sleep can negatively affect a child's emotional, cognitive, behavioral and academic development. Fortunately, snoring and apnea are highly treatable, and there are many effective interventions for behavioral sleep problems."

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Effect of Treatment of Obstructive Sleep Apnea on Seizure Outcomes in Children With Epilepsy

Besides medicine, what else can you do to reduce seizures in children? Check their sleep! JR

Effect of Treatment of Obstructive Sleep Apnea on Seizure Outcomes in Children With Epilepsy

• Eric Segal, MD
, 
• Martina Vendrame, MD, PhD
, 
• Matthew Gregas, PhD
, 
• Tobias Loddenkemper, MD
, 
• Sanjeev V. Kothare, MD

Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

Received 22 October 2011; accepted 8 March 2012.

• Abstract
• Full Text
• PDF
• References

Abstract 

A retrospective review of children with epilepsy and obstructive sleep apnea, treated surgically for their obstructive sleepapnea from January 2008-October 2010, was performed for age, sex, type of epilepsy, antiseizure medications, sleep-study data, and changes in seizure frequency. Twenty-seven subjects (median age, 5 years) with no adjustment to their medications around their time of surgery were identified. Three months after surgery, 10 (37%) patients became seizure-free, three (11%) demonstrated >50% seizure-reduction, and six (22%) exhibited an amelioration of seizure frequency. Two (7%) demonstrated unchanged seizure-frequency, and six (22%) manifested a worsening of seizure frequency. Median seizure frequency before surgery was 8.5 (interquartile range, 2-90), and after surgery, three (interquartile range, 0-75), with a 53% median seizure reduction. Multivariate analysis demonstrated a trend toward seizure freedom with each percentile increase in body mass index and early age of surgery. We conclude that obstructive sleep apnea surgery may decrease seizure frequency, especially in children with elevated body mass index scores and younger age at time of surgery.

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Study Claims Sleep Problems In Young Children Linked To Greater Need For Special Education

A study shows that children with sleeping problems are more likely to require special education.

Kids who snore may be more likely to have behavioral problems, but that may not be all. A new study, published in Pediatricsthis month, found that children with sleep problems through the age of 5 were more likely to require special education by age 8.

Karen Bonuck, a professor of family and social medicine at Yeshiva University's Albert Einstein School of Medicine, led the study that gathered data from 11,049 children with sleep-disordered breathing -- a general term covering snoring and sleep apnea -- and 11,467 children with behavioral sleep problems. Bonuck found that children with one of these disorders were 30 percent more likely to need special education, while children with behavioral sleep problems, such as bedtime refusal or delayed sleep onset, were an additional 7 percent more likely to require speciality courses.

"What we found was that absolutely both behavioral and respiratory problems did increase the likelihood of special education," Bonuck told CBS News' HealthPop. "The take home from this is we need to be looking at these breathing and behavioral sleep problems at very young ages in these children."

The research follows from an earlier study led by Bonuck, published in Pediatrics in March, that linked sleep disorders in young children to the development of behavioral problems such as hyperactivity and aggressiveness.

"This is the strongest evidence to date that snoring, mouth breathing, and apnea can have serious behavioral and social-emotional consequences for children," Bonuck said in a statement.

Though Bonuck's new study does not prove cause and effect, sleep problems in young children may lead to a host of other issues outside the behavioral realm, including special education needs.

"We've got a generation of children potentially at risk from long-term developmental deficits that might occur from these sleep problems," Bonuck told HealthDay. "Parents need to be vigilant."

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Sleep apnea can also impact children

This article discusses how sleep apnea can impact children and when a child should be evaluated by a professional for sleep apnea.

When we think of a sleeping child, the picture that often comes to mind is of a cherubic face relaxed into a smile, with an air of complete peace about her. This, unfortunately, is not the case for many children (and their parents) whose nights are interrupted by a sleep disorder.

It is generally accepted that from time to time in a child’s life there will be periods when a restful night’s sleep is not a given. For a child with a sleep disorder, those nights can become the norm rather than an occasional occurrence. One type of sleep disorder, obstructive sleep apnea syndrome, is more common in children than one might think and can lead to a whole host of issues during the day for a child who is affected by this condition.

There has been plenty of information made available about obstructive sleep apnea in adults over the last 20 years or so, but rarely have we heard about children being affected with the disorder. About 2 percent of children have sleep apnea, which may not seem like a lot, but to put it into context, of the approximately 16,000 children (birth to age 18) in Livingston County, 320 could possibly have this disorder.

Children who are most at risk for this disorder are those with Down syndrome, cerebral palsy, skull and face abnormalities or those who are overweight.

In a report published in the August 2012 issue of Pediatrics, the American Academy of Pediatricians (AAP) recommends that any child who snores on a regular basis be evaluated for sleep apnea. Symptoms of this sleep disorder can include:

• Frequent snoring
• Problems breathing during the night
• Sleepiness during the day
• Difficulty paying attention
• Behavior problems

In order to make a diagnosis of sleep apnea, usually an overnight sleep study called a polysomnogram will be performed. Sensors are attached to the sleeping child to monitor breathing, oxygen levels and brain waves. This information can help the doctors determine whether sleep apnea is present.

If left untreated, complications that can arise from sleep apnea include cardiovascular problems, poor growth and developmental delays. Treatment often begins with the removal of the child’s tonsils and adenoids, as they are commonly enlarged in these children. This is an effective treatment and will often be all that is required for the child to be symptom free.

A second line of treatment is for the child to use a CPAP machine at night. This is a mask that delivers steady air pressure through the nose, keeping the airways open and allowing for more regular breathing. For children who are overweight, weight loss can improve the symptoms but a CPAP may be necessary until the excess weight is lost.

Getting proper sleep is imperative for a child to grow and develop as best they can. Any sleep disorder that interrupts or decreases the quality of their sleep is a problem worth tackling right away. Quiet nights and happy, thriving kids are things every parent hopes for as they navigate the joys and worries of raising children.

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Reasons Why Children Snore

This article discusses many reasons that could cause children to snore.

With school days upon us, a good night's sleep should be on the top of each child's list of supplies. But for some children, getting the rest they need means more than an early bedtime. At Clarity Allergy Center in Chicago, allergy, asthma, and immunology expert, Dr. Brian Rotskoff, is helping parents recognize the signs of childhood obstructive sleep apnea by carefully monitoring childhood snoring and childhood nasal allergies.

Many children snore from time to time, particularly if they have a cold or asthma. But as Dr. Rotskoff, a highly specialized pediatric nasal congestion and sleep apnea expert explains, "if your child is a restless sleeper who chronically snores and mouth breaths and shows signs of daytime difficulties, obstructive sleep apnea could be the cause." He also points out that the symptoms ofsleep apnea in kids can be subtler than those of adult sleep apnea.

Beyond restless nights, Dr. Rotskoff encourages parents who suspect their child may have obstructive sleep apnea to watch for these warning signs that can begin as early as 2-6 years of age.

Nighttime Sleep Apnea Symptoms

• Persistent snoring and mouth breathing
• Gasping or labored breathing
• Frequent bedwetting beyond normal age range
• Night sweats
• Unusual sleeping positions

Daytime Sleep Apnea Symptoms

• Allergies, asthma, or frequent ear infections
• Poor school performance or trouble focusing on tasks
• Behavioral or social problems
• Bad mood or constant agitation
• Depression or anxiety

Childhood Nasal Allergies and Asthma

It's highly common for children with sleep apnea to have other breathing issues. "Some children are just persistent snorers and don't necessarily have sleep apnea," acknowledges Dr. Rotskoff, "but compounding issues, such as enlarged tonsils and adenoids, can elevate to sleep apnea."

Dr. Rotskoff is one of few allergy and asthma experts to give childhood sleep apnea the attention it deserves. Even if your child is getting 10-12 hours of sleep each night, sleep apnea can cause enough disruption to affect mood, school performance, and overall behavior. "Studies show that middle school and high school kids with moderate to severe sleep apnea achieve lower grades and have greater trouble focusing or paying attention in class," he says.

If you think your child suffers from sleep apnea, Dr. Rotskoff suggests a thorough exploration of all symptoms and physical factors that could contribute to breathing problems. Beyond monitoring your child's tonsil and adenoid size, Dr. Rotskoff will evaluate their soft palate and uvula, tongue, jaw positioning, and nasal passages and airways. He works closely with parents to determine the most conservative and effective treatment.

"Addressing your child's sleep issues early will not only improve academic and social performance, it will also position them for healthy adult sleep habits," concludes Dr. Rotskoff.

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