Snoring And Cognitive Problems In Children

Brain oxygen levels and blood pressure may play a role in the complex relationship between sleep-disordered breathing (SDB) and cognitive problems in children, a U.S. study finds.

About two-thirds of children with SDB (snoring or obstructive sleep apnea) have some degree of cognitive deficit, but it’s been difficult to match the severity of cognitive deficit to the severity of the SDB. This suggests that other factors may be involved or that the correct factors weren’t being measured, according to background information in an American Thoracic Society news release about the study.

“A history of snoring is a predictor for cognitive deficit in children with SDB,” study principal investigator Dr. Raouf Amin, a professor of pediatrics and director of the division of pulmonary medicine at Cincinnati Children’s Hospital Medical Center, said in the news release.

“However, the frequency of apnea events during sleep does not predict cognitive deficit and does not correlate with the degree of cognitive deficit. Such a paradox raised the question of whether there are some variables that we do not traditionally measure in the sleep laboratory that might modify the effect of SDB on cognition,” Amin said.

For this study, which included children aged 7 to 13, the researchers used infrared spectroscopy to determine whether a new factor — the degree to which the brain’s blood remains oxygenated during sleep — could explain variability in cognitive dysfunction better than SDB severity. The children’s blood pressure was also measured.

The results showed that children with snoring had lower regional cerebral oxygen concentration than healthy children. However, children with sleep apnea (usually considered a more severe type of SDB) had higher regional cerebral oxygen concentration than children with just snoring.

“During normal sleep, when breathing appears to be stable, there seems to be higher oxygen in the brain among children with sleep apnea compared even to normal children,” Amin said. “Children with sleep apnea have higher [blood pressure] compared to children with snoring. This may explain why, paradoxically, we find higher oxygen levels in children with [obstructive sleep apnea].”

“By taking into account the role of blood pressure in regulating the amount of oxygen concentration in the brain, we might have a better understanding of the relationship between sleep-disordered breathing and cognitive deficit,” said Amin, who added that this research may prove important in future prevention and treatment efforts.

The study was published in the first issue for November of the American Journal of Respiratory and Critical Care Medicine.

Children With OSAS May Have Behavioral Problems

Many children snore. In fact, it is estimated that between 3% and 12% of preschool age children snore. The majority of these children are well, without other symptoms, and have primary snoring.

Though a growing percentage of children that snore, can also develop obstructive sleep apnea syndrome (OSAS), a condition that is being increasingly recognized by physicians as a leading contributor of school and behavior problems in many children.

A recent guideline from the American Academy of Pediatrics, Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, should help Pediatricians more readily recognize, diagnosis and treat children with OSAS.

How do you know if your child is just a normal snorer or if he has obstructive sleep apnea? Children who snore and do not have OSAS should be otherwise well, without daytime sleepiness and they should have normal sleep patterns. In contrast to normal primary snoring, children with OSAS usually have disrupted sleep with short 'pauses, snorts, or gasps' in their sleep. Children with OSAS may also have behavioral problems, a short attention span and problems at school.

Other signs or symptoms might include:

large tonsils and/or adenoids with frequent mouth breathing, hyponasal speech and nasal obstruction
poor weight gain
being overweight
high blood pressure

Testing can be done if it is suspected that your child has OSAS, including an overnight sleep study (nocturnal polysomnography). Unfortunately, it may be hard to find a hospital or central that does pediatric sleep studies unless you live in a large metropolitan area.

Other testing may include audiotaping or videotaping your child's sleep, although you would likely need a specialist to interpret the tapes, use of overnight pulse oximetry to measure oxygen levels while he sleeps, or just performing a sleep study during a day time nap. These other tests have been shown to be useful if they do show OSAS, but a child may still have OSAS if these tests are normal, so further testing may need to be done if the testing is normal but it is still suspected that your child has sleep apnea.

Once it is determined that your child has obstructive sleep apnea syndrome, it will be time to discuss treatment options, which usually include removing enlarged adenoids and tonsils (adenotonsillectomy). Other treatments might include treating a child's allergies and helping overweight children lose weight. Anti-snoring therapy with a nasal mask or jaw supporters are another treatment option for children who can't have surgery or who continue to have obstructive sleep apnea after their adenoids and tonsils are removed.

Doctors that specialize in treating children with OSAS include pediatric otolaryngologists (ENT specialist), pulmonologists, and neurologists. If your Pediatrician diagnoses your child with obstructive sleep apnea, you will likely need to see one of these doctors. Be sure to find one that has experience taking care of children with this problem. You might also see a specialist if you suspect that your child has OSA and testing is negative or if you are unable to get any testing done.

Remember to be especially suspicious that your child may have OSA if he regularly snores and has apnea, daytime sleepiness, and/or school and behavioral problems.


Reference: Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, Pediatrics.