Sleep Disordered Breathing (SDB) is a blanket term for various forms of sleep disorders. Not all are taken seriously.
However, scientists have discovered that common sleep disorders such as snoring and mouth breathing may be responsible for learning difficulties and hyperactivity, together with a number of behavioural or ‘brain’ problems in children.
Scientists have reason to believe that even mild cases of SDB have serious consequences for children. As a result, some children may have been misdiagnosed as having attention deficit/hyperactivity disorder or ADHD (JAMA, 2007).
Around one in five children suffer from SDB, which can range from snoring, to the most severe form known as obstructive sleep apnoea (OSA). Apnoea refers to a temporary absence of breathing and in OSA this is caused by a temporary, but repeated, blockage of airflow to the lungs.
Over the past few years, numerous behavioural problems have been associated with SDB in children including aggression, impulsivity, anxiety, conduct problems, hyperactivity and inattention.
However, a multicentre US study provides compelling evidence for a cause and effect relationship of nocturnal breathing and behavioural difficulties. In this study, 105 children aged five to 13 were involved. Of these, 78 were suspected of having SDB, 22 of whom had met the criteria for ADHD, as judged by a child psychiatrist.
One year after undergoing surgery to relieve their SDB, 11 of the 22 no longer met the criteria for an ADHD diagnosis. In addition, all the children who had undergone operations showed dramatic improvements in terms of hyperactivity, inattention and daytime sleepiness (Paediatrics, 2006).
“These findings help support the idea that SDB is actually helping to cause behavioural problems in children,” said Ronald Chervin, lead author of the study.
In another of the many studies carried out, researchers found that children who were habitual snorers, in comparison to those who were not, were about four times more likely to have developed new hyperactivity four years later. In other words, snoring early in life predicted new or worsened behavioural problems four years later.
Other studies confirmed connections between bad night-time breathing and hyperactivity. While these results don’t prove that SDB causes hyperactive behaviour, they do provide important evidence to support the hypothesis of a connection between them.
There are a number of possible causes for the development of SDB in children, including enlarged tonsils and adenoids, problems of the nervous system, genetic disorders such as Down’s Syndrome, and structural abnormalities of the craniofacial area (J. Pediatr. Psychol., 2006).
However, during the past few years there has been a great deal of interest in the possible connection between SDB and childhood obesity. This is because the prevalence of SDB in children is rising in tandem with the increase of overweight children.
In the US, for example, the childhood obesity rate has more than doubled for children aged between two and five and more than tripled for those aged between six and 11 over the past three decades (JAMA, 2007).
Obesity causes SDB by increasing the amount of fat tissue in the throat, neck and chest wall which, in turn, causes an increase in upper airways resistance and makes the effort of breathing hard work (Pediatr. Nurs., 2006).
This is not a factor attributed solely to children, as adults who have increased in weight have often found themselves suffering from sleep apnoea though they had never suffered from it in the past.
The conventional treatments for SDB include Continuous Positive Airway Pressure (CPAP) therapy. This involves an electronic device which applies positive pressure using a nasal mask which prevents the throat and airways from collapsing in on themselves while the child is sleeping.
Studies have found this to be effective. (J. Paediatr., 1995). The side-effects could be the fact that the equipment needs to be worn through the night when sleeping: not all children can adapt to this. It also causes some side effects such as a dry nose, irritation on the skin of the face, bloating of the stomach, sore eyes and headaches (Paediatr. Nurs., 2006).
Surgery is another conventional treatment. Removal of the tonsils and adenoids is the initial treatment. Studies have shown this to be successful in 83 per cent of children, together with enhancing the children’s quality of life. In children who are overweight, or with severe SDB, the operation is rarely sufficient to solve the problems. In addition, with surgery there are the usual risks involved.
The signs to look for with children suffering from SDB are snoring, laboured breathing, snorting or gasping, pauses in breathing, mouth breathing, unusual sleep posture (such as knees tucked under the chest, mouth open and neck hyper extended), nightmares of drowning or choking, hyperactivity, inattention, difficulty following directions and poor memory (JAMA, 2007).
It is clear that recognising SDB early in a child’s development is crucial. However, it is possible a child may suffer from some form of SDB for years before, if at all, it is recognised.
The most important factor is for parents to be informed by recognising the signs and symptoms and then acting. In addition, whether children or adults, we should not underestimate the importance of a good night’s sleep.
kathryn@maltanet.net