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Snoring in Children – Is it Time to See Your Doctor?

There is a well-established connection between children’s behavioural problems and breathing disorders during sleep but recently published research from the University of Arizona has again highlighted the need for parents to identify their children’s sleep breathing problems as early as possible.  

Professor Michelle Perfect from the School Psychology program at the University of Arizona  is the lead author of a five year study looking at the sleep patterns and behaviour disorders of 263 children; Dr Perfect says the study’s results indicate that sleep disordered breathing, often present with snoring, could contribute to “hyperactivity, learning and behavioural and emotional deregulation in the classroom.” The Arizona study found there was a four to five times greater risk of children with sleep apnea having behavioural issues.

But Isn’t Snoring Normal?

Snoring in children is not ‘normal’ - Dr Margot Davey, Director of the Children's Sleep Centre at Monash Children’s,  Monash Medical Centre  is adamant that parents should not see their children’s snoring as “cute, normal or something they will outgrow”  because in connection with obstructed breathing “there is evidence of cardiovascular effects and neurocognitive effects and behaviourally there is evidence of effects such as poorer attention, difficulties concentrating, difficulties following through and in three to five year olds, significant behavioural issues.”  There are no long term studies showing the effects of children snoring on health outcomes in later adult life. However, the health effects of sleep apnea in adults and the link between sleep disordered breathing and health and behavioural effects on children, suggest that parents should be alert for signs of sleep disordered breathing in children and act early in seeking a diagnosis.

Parents have been found to rarely mention their child’s snoring to their family doctor so sleep disordered breathing is underdiagnosed in general practice even when children have histories of frequent snoring. 

Connection Between Sleep Breathing and the Behaviour and Health of Children

Sleep Disordered Breathing refers to breathing being disrupted by obstructed airways during sleep.  Past studies have demonstrated a connection between children’s sleeping habits and patterns and conditions such as hyperactivity and ADHD.

A UK longitudinal study published in 2012 looked at more than 11,000 children from infancy to 11 years old to examine the effects of snoring, apnea, and mouth-breathing patterns, and found significant links between a child’s behaviour and their sleep quality. For example the UK study found that sleep disordered breathing in early childhood was linked to a child being 40% more likely to have behavioural problems at age four and a child being 70% more likely to have behavioural problems at age seven. Dr Karen Bonuck from the Albert Einstein College of Medicine, New York and her co-authors in the UK study, say the most significant long-term effects occur “in children with the greatest overall levels of snoring, apnea, and mouth breathing throughout, peaking at 30 months”  and explain that “this may be because of the increased vulnerability to sleep disordered breathing effects during this early critical period of brain development, when there is the greatest need for sleep.

Experts at the Children’s Research Centre at the University of Adelaide point out that children who snore are at risk of other health effects: “even the mildest form of sleep breathing disorder can affect the brain, heart, blood vessels and pancreas, and that it may also increase the risk of diabetes, obesity and poor cardiovascular health later on in life.”  Between 10 and 20% of primary school age children will snore but Professor Declan Kennedy from the Department of Respiratory and Sleep Medicine in Paediatrics at the University of Adelaide explains that only about 3 % of children will be diagnosed with obstructive sleep apnea.

Sleep Disordered Breathing has been frequently linked to Attention Deficit Hyperactivity Disorder (ADHD) in children  with experts  such as Dr. Ronald Chervin, a neurologist and director of University of Michigan Sleep Disorders Center saying researchers are “getting closer and closer to a causal claim” between breathing problems during sleep and ADHD symptoms in children. The diagnosis of ADHD is estimated to have risen between 22 and 24 percent in the last few years with nearly one in five high school age boys in the United States being given a diagnosis of attention deficit hyperactivity disorder so parents are naturally looking for possible causes and prevention strategies.  If attention problems may be sleep related, then it is important that parents seek advice and help from a doctor when their children are still young. 

Snoring and Sleep Breathing – What Should Parents Look For?

Professor Davey explains that in combination or alone, the following are indicators that your child might have sleep disordered breathing. Professor Kennedy adds that a parent’s intuitive concern that their child’s breathing is not normal at night is enough of a reason to seek advice from the family doctor: