Sleep Apnea Steals More Than Sound Slumber From Kids

Condition also leads to problems with learning and attention

SUNDAY, Sept. 1, 2002 (HealthDayNews) -- The troubles of children with sleep apnea may stretch far beyond not getting a good night's sleep.

Researchers at the Baylor College of Medicine in Houston have found the more severe the condition, the more impaired the child's performance on tests of intelligence, memory, academic performance, social skills and attention.

These findings and others raise the possibility that attention-deficit hyperactivity disorder, or ADHD, and other behavioral and learning problems may sometimes be a symptom of obstructive sleep apnea syndrome (OSAS).

"I think it's a possibility," says Dr. Daniel G. Glaze, lead author of the study and an associate professor in the departments of pediatrics and neurology at Baylor. "If they don't sleep well at night, they can't function in an appropriate way during the day. One hypothesis is that the hyperactivity is a mechanism of trying to keep yourself awake."

Fortunately, many of the kids in this study experienced dramatic improvements in quality of life when they had their tonsils and adenoids surgically removed.

"The data is incomplete because the study is still ongoing, but we have enough data at the six-month follow-up period to see dramatic improvements in several aspects of quality of life," says Dr. Michael Stewart, a co-author of the study, which was presented at the recent annual meeting of the American Society of Pediatric Otolaryngology in Boca Raton, Fla.

Children with OSAS experience an obstruction of their upper airway -- often but not always because of enlarged tonsils and/or adenoids -- that disrupts their breathing while they sleep.

One telltale symptom is snoring. Although the condition is well-recognized in adults, it is just beginning to gain attention in the pediatric world. At least 2 percent of children are estimated to suffer from the condition.

In children, the condition tends to peak in elementary school-age children, which is when tonsils and adenoids tend to be larger, says Dr. Michael Light, a professor of clinical pediatrics at the University of Miami School of Medicine and author of the Clinician's Guide to Pediatric Chronic Illness. This is also the time when children are making huge strides in their cognitive development.

"The main job of kids is to go to school. If they're not sleeping well at night, they'll have problems concentrating. That has become very clear," Glaze says. "Our preliminary findings indicate that breathing problems during sleep impact on a number of parameters including intelligence, memory, academic performance, behavior. And it impacts on families as well as on the child."

The researchers looked at 23 boys and girls between the ages of 5 and 13 who had difficulty breathing while they slept. Intelligence, memory, academic performance, attention and adaptive behavior were measured both before and after they had tonsillectomies and adenoidectomies.

Six months after surgery, the children exhibited dramatic improvements in their quality of life. One question that remains is whether these improvements will be sustained at a year or longer.

"It was our finding that, following [the surgeries] at six months, there were significant improvements on quality-of-life questionnaires," Glaze says. "As to improvements in behavior and cognition, we have not shown this. The subjects will be retested at one year to see if there is improvement and, if so, in what areas."

The quality-of-life improvements also extended to the families of children diagnosed with OSAS.

"Often when I see kids come in, the biggest problem is with their parents," Glaze says. "Several mothers had to quit their jobs because they were up and down with the kids at night, they were driving when they were drowsy, and they were falling asleep on the job."

Heartening as these results are, not all cases of OSAS can be explained by the presence of enlarged tonsils and adenoids.

Obesity, for instance, is another major risk factor for the condition, says Light, who is about to start studying the relationship between sleep and obesity.

"We haven't even scratched the surface of it," he says.

What To Do

For more information on OSAS, visit Stanford University or ABC7Chicago.com.

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