Snoring: A Clue to a Child’s Behavioral Problems
From Clinical Update, Summer 2003
Abstract: Children with behavioral problems who snore may need to be evaluated for sleep apnea.
Pediatricians often struggle to find cause for a patient’s behavioral problems at school and at home. However, a pediatric pulmonologist at Brenner Children’s Hospital says the answer may be as simple as a good night’s sleep.
“One of the first things a pediatrician should ask a parent when the parent reports behavioral problems at school is, ‘Does the child snore?’” said Michael S. Schechter, M.D., a pediatric pulmonologist at Brenner Children’s Hospital, part of Wake Forest University Baptist Medical Center. “This applies to children who have been diagnosed with ADHD as well.”
Ten to 12 percent of children ages 2 to 13 habitually snore, according to Schechter. “Only 25 percent will have sleep apnea,” he said.
Sleep apnea in children usually occurs when enlarged tonsils block the child’s airway and prevent airflow during sleep. These interruptions in sleep leave the child feeling fatigued throughout the day.
“However, many parents don’t realize their child isn’t sleeping well,” said Schechter. “Many think their child would be drowsy and nod off during the day if they weren’t sleeping properly. For children, however, the opposite may be true. Many actually have problems with behavior, in addition to learning problems and behavior disorders.”
Sleep apnea can only be diagnosed with certainty by performing a sleep study, according to Schechter. At WFUBMC, children as well as adults are evaluated at the Sleep Disorders Center. The child comes to the hospital and spends the night in a sleep lab, tethered to computers that monitor the child’s airflow, carbon dioxide levels, blood oxygen levels and how often they awake during sleep.
Only 25 percent of children who snore will be diagnosed with sleep apnea, but for those who have the disorder, it can usually be corrected surgically.
“A tonsillectomy can correct sleep apnea in the majority of children who have no other underlying facial abnormalities,” Schechter said. “Parents often see immediate results after the child has healed from the surgery. Some children with snoring have nasal allergies and their snoring can be improved with treatments such as steroid nasal spray.”
Children diagnosed with Down’s Syndrome are very susceptible to obstructive sleep apnea, as are those with other genetic disorders and neuromuscular diseases. For these children, other treatment approaches might be necessary.
It is important to remember that most children who snore do not experience significant disruptions in their sleep, according to Schechter.
“Children with loud snoring every night, especially if associated with learning or behavioral problems, should be evaluated for possible apnea. In addition to tonsillar enlargement, one of the most common causes of snoring is allergies,” he said. “Some children with other medical problems often snore as well. If the patient is not experiencing behavioral problems during the day, then he or she is probably getting adequate rest.”