Children with sleep-related breathing disorders – such as apnea and snoring – are twice as likely to have behavioral problems as kids without them, a new study finds.
Researchers with Albert Einstein College of Medicine of Yeshiva University tracked more than 11,000 children for more than six years and found that young children with sleep-disordered breathing are prone to developing hyperactivity, aggressiveness, emotional problems and difficulty with peer relationships.
The findings, published in the journal Pediatrics, suggest breathing problems may decrease oxygen and increase carbon dioxide levels in the brain, interrupt the restorative processes of sleep and cause other biochemical disruptions. These problems may affect children’s ability to pay attention, plan ahead, organize their thoughts and control their impulses.
"This is the strongest evidence to date that snoring, mouth breathing, and apnea can have serious behavioral and social-emotional consequences for children," said lead author Karen Bonuck, a family-health specialist at Einstein. "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."
Sleep-disordered breathing is a general term for breathing difficulties during sleep. Its hallmarks are snoring – typically accompanied by mouth breathing -- and sleep apnea. It peaks between 2 and 6 years of age in children, but can develop earlier. About 1 in 10 children snore and up to 4 percent have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery.
The new study involved children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.
Parents were asked to fill out questionnaires about their children's sleep patterns at various intervals, from 6 to 69 months of age. When their children were 4 and 7 years old, parents were surveyed about a child's inattention/hyperactivity, emotional symptoms (anxiety and depression), peer problems, conduct problems (aggressiveness and rule-breaking), and social behavior.
"We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems," said Bonuck. "The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures."
The study was partly funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.