Snoring and your child's behavior and learning

Dr. P's Pediatric Journal Club

The study --

• 78 children, ages 5-13, who were scheduled to have their tonsils and adenoids removed due to "sleep disordered breathing" were compared to 22 children (the "control group") having other minor surgery.
• Testing prior to surgery included a "sleep study", parents' description of the child's behavior, cognitive testing, any psychiatric diagnoses, and sleepiness during the day.

What the study found --

• Only half of the children with "sleep disordered breathing" turned out to have obstructive sleep apnea on sleep tests.
• Children who had their tonsils and adenoids out were more likely to be hyperactive, inattentive, diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), and sleepy.
• One year later, the groups did not differ on these measures, suggesting that in some children removing the tonsils and adenoids improved their hyperactive and inattentive behaviors.

Dr. P comments

Since the link between disordered sleep and children's behavior and learning is new, it's hard to know what to make of it. The returns are by no means all in. Still, as of April 2006, here's what we think we know:

• Children with severe "obstructive sleep apnea" (i.e., who snore and who have episodes lasting longer than 15 seconds in which they can't move air in or out) are at risk for high blood pressure, poor growth, heart problems.
• Children with less severe symptoms seem to have more behavioral problems (such as ADHD) and more learning challenges (such as poor attention).
• Children who snore loudly but don't have apnea may have similar behavioral and learning risks, although this is as yet unclear.
• This study suggests (but does not prove) that taking the adenoids out in such kids may improve these problems in some of them.
  

Here's the dilemma: everyone is in agreement that true "obstructive sleep apnea" often requires surgery for medical reasons. And, as more data comes in, we'll better know how often this also results in improved behavior and academic functioning in kids.

But what about the child who snores but has no apnea, and who is having behavioral or learning problems? Lots of normal kids snore and there is no "cure" for snoring (except perhaps treating allergies at night). Should he also have his adenoids lopped out to see if it would help? I think the prudent answer for now is no, but stay tuned as new scientific studies come in.

Dr. P's Bottom Line
Practically, here's what I suggest if your child is a major league snorer:
Watch him/her to see if there are periods at night in which his chest moves but the snoring stops and all is silent because air is not flowing in or out. Time how long it lasts. Make a tape recording or video to show your pedi. If obstructive sleep apnea is suggested, get a sleep study done to confirm the diagnosis.

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Article cited:
Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy Chervin R, et al. Pediatrics. April, 2006

Related Topics: Snoring May Run in Families, Kids Who Snore Could Be Hyperactive Later

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