Snore-Gonomics - Snoring

Childhood Snoring

Childhood Snoring

The health of our children is always a primary concern. For this reason, the following information is presented in clinical terms in order to exemplify some extreme medical conditions that may be associated with snoring in children. This information is provided as a reference, and is not intended as a tool for self-diagnosis. By becoming more aware of the possibilities that can be associated with snoring in a child, one is much better prepared to discuss the matter with a trained health professional.

For years snoring has been something a joke, not a worry. Over the past decade though, research revealed it to be a serious condition that can have long-term effects. One such recent research project looked at middle school academic performance in children who were previous snorers.

The study was performed at Kosair Children’s Hospital Research Institute in Louisville Kentucky. 1588 children surveys were analyzed. Children were placed into high-performance (top 25% of school) and low-performance (lower 25% of school) groups based on academic performance. Both groups had similar snoring patterns in middle school.

Low Performance Group = 797

One parent smokes 31%

Loud/frequent early childhood snoring 13%

Kids needing surgical correction 3%

Allergies 5.5%

ADHD 5%

Average GPA = 2.75

High Performance Group = 791

One parent smokes 24%

Loud/frequent early childhood snoring 5%

Kids needing surgical correction 0.9%

Allergies 4.8%

ADHD 3.5%

Average GPA = 3.78

To read more on this go to www.pediatrics.org (Pediatrics, vol. 107, No. 6. June 2001, pg 1394)

If you are a parent of a child who snores, this information should get your attention. Frequent and loud snoring is known to cause prolonged periods of abnormal breathing including lowered blood oxygen levels and higher carbon dioxide levels during the night. Low oxygen levels are not good to the developing brain. Over time, these changes can lead to high blood pressure, heart, lung, and brain changes too.

So what should you do if you have a child who snores? First, make an appointment to discuss it with your child’s physician. Next, while waiting for your appointment, make a record of how often your child snores, how loudly, and if s/he has any pauses in breathing while sleeping. Snoring at any age should be addressed. Depending on the degree of your child’s snoring symptoms, your physician may prescribe allergy medications (liquids/pills/or nose sprays), or refer you to an ENT if symptoms warrant.

There is a lot that can be done with medicines and allergy treatments before a child needs a tonsillectomy/ adenoidectomy for snoring. Regardless, do not accept an “oh, she will grow out of it.” This study documents the effects of unchecked years of snoring — poorer school performance and increased ADHD. The snoring may go away as their heads grow, but the effects of abnormal breathing does not necessarily go away.

Did you know that about 10-12% of children regularly snore? Snoring occurs during sleep when the child is breathing in and there is some blockage of air passing through the back of the mouth. The opening and closing of the air passage causes a vibration of the tissues in the throat. The loudness is affected by how much air is passing through and how fast the throat tissue is vibrating. Snoring is abnormal in otherwise healthy children. Sometimes it can be a sign of a respiratory infection, a stuffy nose or allergy; other times it may be a symptom of obstructive sleep apnea (OSA).

About two percent of young children have OSA which is when the airway collapses and blocks the throat. This causes frequent pauses in breathing which can last from several seconds to a minute and oxygen levels subsequently fall. The brain briefly wakes up and alerts the body to breathe. This effort results in the child gasping or snorting, waking up and starting to breathe again. This can happen hundreds of times in a night. Because of these repeated arousals to breathe the child may not get enough quality sleep and is likely to be sleepy or overtired during the day. Sleepiness in children often manifests as hyperactive behaviors.

Undiagnosed and untreated OSA may contribute to daytime sleepiness, morning headaches, bed wetting, mouth breathing, and behavioral problems including difficulties at school. Following a night of poor sleep, children are more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit hyperactivity disorder (ADHD). Many studies show that OSA and learning and behavioral problems are linked even in very young children. A large survey also found that children who snored between the ages of two to six years were three times more likely to have behavioral and intellectual problems in middle school. Furthermore, research also suggests that children with OSA are at risk of developing heart and lung problems which may lead to serious problems when the children get older.

It was previously thought that primary snoring was normal (i.e., snoring which does not cause pauses in breathing, frequent arousals, or drops in oxygen levels). However, new research now shows that even children with primary snoring are still more likely to perform below their peers in school, particularly in language tests, spelling, and tests of IQ. They are also more likely to have behavioral problems.

Enlarged tonsils and adenoids are usually the cause of snoring in children since tonsils are quite large in comparison to the size of the throat especially between the ages of about five and seven years. Removing the tonsils and adenoids often stops the snoring. In fact, taking out the tonsils and adenoids also improves academic performance as well as behavior. Obesity increases the risk of OSA. Fat deposits around the throat can cause it to constrict, and fat in the stomach can prevent the diaphragm from functioning properly. Approximately 20-40% of obese children suffer from OSA so it is important for children to maintain an appropriate weight.

Children with allergies are more likely to have blocked nasal passages and this can explain why some children only snore during allergy season or when they have a cold. In these cases taking allergy medication can help stop the snoring. In a small group of children poor muscle tone in the airway or abnormalities of facial development (including a small jaw) rather than enlarged tonsils and adenoids can be the problem. In these cases a breathing machine which blows air into the lungs may be required.

During the night, children with OSA may:

• Snore loudly and on a regular basis.

• Have pauses, gasps, and snorts and actually stop breathing.

• The snorts or gasps may waken them and disrupt their sleep.

• Be restless or sleep in abnormal positions

• Sleep in an elevated position or with their neck extended.

• Sweat heavily during sleep.

• Have behavioral problems such as hyperactivity (mimicking ADHD).

• Have schooling difficulties.

• Be difficult to wake up.

• Have headaches during the day, especially in the morning.

• Be irritable, agitated, aggressive, and cranky.

• Be so sleepy during the day that they actually fall asleep.

• Speak with a nasal voice and breathe regularly through the mouth.

If you suspect your child may have symptoms of OSA, talk to your child’s doctor instead of trying to ignore the snoring. A recent guideline from the American Academy of Pediatrics, Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, should help doctors more readily recognize, diagnose, and treat children with OSA. Your doctor may refer your child to a sleep specialist who may order an overnight sleep study. This study will record the child’s sleep, brain waves, body movements, heartbeat, breathing, oxygen levels, and snoring to determine a diagnosis. Sleep specialists have special training in sleep medicine and can offer you the most appropriate treatment.

Children should follow these steps to get a good night’s sleep:

• Follow a consistent bedtime routine.
• Establish a relaxing setting at bedtime.
• Get a full night’s sleep every night.
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant prior to bedtime.
• Do not go to bed hungry, but don’t eat a big meal before bedtime either.
• The bedroom should be quiet, dark and a little bit cool.
• Get up the same time every morning.

Experts recommend that children in pre-school sleep between 11-13 hours a night, and school-aged children between 10-11 hours of sleep a night.

An abstract of this research was presented June 13, 2007 at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies. Adapted from materials provided by American Academy of Sleep Medicine.

Childhood Snoring Articles

Snoring Children: Poor Sleep Hygiene in Children Associated With Behavioral Problems

Science Daily (Jun. 13, 2007)- A snoring child’s poor sleep hygiene habits can have a negative influence on his or her daytime behavior, according to a new study. Lisa Witcher of the University of Louisville, who authored the study, interviewed the parents of 52 children between the ages of five and eight who were reported to snore “frequently” to “almost always”. The children underwent an overnight polysomnography, and parents were asked to complete the Children’s Sleep Hygiene Scale (CSHS) and the Conners’ Parent Rating Scales-Revised (CPRS-R)

The results showed strong negative correlations between the CSHS overall sleep hygiene score and CPRS-R total externalizing behaviors. The CSHS total was also negatively correlated with the CPRS-R Cognitive/inattention, problems, hyperactivity, perfectionism, ADHD index, and restless and impulsivity total scores among others. Further, the CSHS physiological, cognitive, emotional, environmental, and bedtime routine subscales were also significantly negatively correlated with externalizing behaviors on the CPRS-R. “The parental reports indicate poorer sleep hygiene is associated with both internalizing and externalizing behavior problems, specifically those associated with ADHD symptoms,” said Witcher. “While no causation can be inferred, an overlap between daytime behavior problems, poor sleep hygiene, and potentially problematic bedtime behaviors in snoring children may exist and deserves further study.

Snoring is a sound made in the upper airway of your throat as you sleep. It normally occurs as you breathe in air. It has been found in all age groups. Between 10-12 percent of children are found to snore. Almost everyone is likely to snore at one time or another. Snoring can, however, be indicative of a more serious condition, namely, obstructive sleep apnea (OSA), which refers to a sleep-related breathing disorder that causes one’s body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway, which prevents air from getting into the lungs. Parents who suspect that their child might be suffering from OSA, or another sleep disorder, are encouraged to consult with their child’s pediatrician, who will refer them to a sleep specialist.

Snoring In Children Might Be An Allergic Type Disease

Science Daily (Jun. 6, 2007)- New Australian research from the Woolcock Institute of Medical Research shows that children who snore have different risk factors to adults who snore. The research found that snoring is in fact part of the spectrum of childhood allergic diseases. So whilst the condition looks and sounds similar in adults and children it can have quite different causes and risk factors. The study published in the latest edition of the international medical journal, Pediatric Pulmonology has established children with rhinitis who were first born, were exposed to maternal tobacco smoke during the first year of life and/or who had asthma and/or eczema at age five years were more likely to snore. Breastfeeding, birth weight, body mass index at age 4.5 years and respiratory function whilst awake were found to be unrelated.

The study cohort was drawn from participants in the Australian Childhood Asthma Prevention Study (CAPS) — a randomized controlled trial of dietary intervention and house dust mite avoidance during the first five years of life 219 children within the original study group had rhinitis and of these, 213 could provide information on snoring. Almost 60% of these children snored at least once per week including 26% who snored more than three nights per week.

This is a very high prevalence in five year old children and is partly due to all of the children having rhinitis which is often found in children who snore.Dr Nat Marshall, from Sydney’s Woolcock Institute of Medical Research said the study aimed to investigate whether the risk factors for snoring among pre-school children with rhinitis were similar to those for allergic diseases in a group of children who have been monitored since before they were born.

“Our findings were consistent with the view that snoring forms part of the spectrum of allergic diseases in childhood,” he said. While the study findings are limited to children with rhinitis, Dr Marshall explained the observed associations with risk factors could apply to the general population where previous studies have also found strong associations between allergic or inflammatory diseases and snoring. “Snoring can be an early manifestation of more serious sleep-disordered breathing, so it’s not necessarily a harmless condition,” Dr Marshall added. “In adults habitual snoring is seen as being caused by anatomical problems in the airway or obesity. But in children it seems that snoring is much more closely related allergy and inflammation”. “Our data hopefully contribute to a clinician’s ability to effectively spot snoring in pre-school children in order to identify potentially more serious obstructive sleep apnea.”

Adapted from materials provided by Woolcock Institute of Medical Research.

The content contained within Snore-Gonomics© is not a substitute for medical or other professional advice and/or services from a qualified health care provider familiar with your unique situation. We recommend consulting a qualified professional if you have concerns about your, or your child’s medical condition.