Snoring is usually associated with visions of old fat men and is often considered comical.. Approximately 12% of children under the age of 10 are habitual snorers. Over the years it has been shown that children who snorer do not preform as well in school. Parents may have heard their children mildly snore, but have not considered that it may have negative ramifications, especially if it is quiet like a little kitten purring. Research has shown that if the snoring is a chronic condition, it could be a sign of an underlying sleep disorder that may be having negative effects on behavior and learning.
Pediatric physicians are beginning to think about sleep quality when evaluating ADHD cases. The American Academy of Pediatric Medicine believes all snoring should be thoroughly evaluated in children.
Dr. Judith Owens, who is in charge of the Pediatric Sleep Disorders Clinic at Hasbro Children’s Hospital in Providence, R.I., feels that a child’s sleep must be investigated when the child exhibits attention problems, irritability, aggressive behavior, academic issues, or mood issues. Dr Ira Shapira a general dentist in Chicago has long been concerned with treatment of snoring and Sleep Apnea. Twenty five years ago when his 3 year old son was snoring heavily he consulted ENT's And pediatricians with his concerns but was told it was not a problem. When Billy was 5 years old he was held back from starting kindergarten and diagnosed with ADHD. At this point Dr Shapira took matters into his own hands. A sleep test at Rush Medical School showed severe apnea which was treated by removal of tonsils and adenoids and orthodontic widening of the mouth. Correction of the Sleep Apnea resulted in better behavior and school performance. The Drug of choice, according to Dr Shapira, was good sleep and Oxygen instead or Ritalin. As a result of his experience Dr Shapira has dedicated his life to insuring diagnosis and treatment of sleep apnea and snoring at all ages. Read his story at http://www.ihatecpap.com/
Dr. Michael Schechter,an Emory University pediatric pulmonologist, feels that sleep problems are fairly common, and that snoring can signal either neurological problems or blockages in airways that may lead to sleep apnea. Dr. Schechter states that “habitual snorers are 2 to 3 times more likely than non-snorers to suffer the kinds of behavior and learning problems more typically associated with attention deficit and hyperactivity disorder.”
In 2006 in the August 22 issue of the global online journal Public Library of Science Medicine John Hopkins researchers published an article: CHILDHOOD SLEEP APNEA LINKED TO BRAIN DAMAGE, LOWER IQ. This article should be a wake up call to every parent who has a child with snoring, apnea or breathing problems. It is also a wake up call for the pediatric medical community that enlarged tonsils and adenoids can no longer be taken lightly. It has long been known that children who snore or who have large tonsils or adenoids do not do as well in school but now we know these conditions can cause permanent brain damage and we can not idly wait for children to outgrow their tonsils and adenoids.
This was the first study showing permanent neural changes in the brains of children damaging two brain structures tied to learning ability. The specialized MRI showed damage to hippocampus and the right frontal cortex. Utilizing IQ tests and other performance tests measuring the verbal performance, memory and higher-level functions the researchers linked the changes to deficits in neuropsychological performance.
The hippocampus, a structure located in the temporal lobe, is central to learning and to memory storage. The right frontal cortex governs higher-level thinking, such as accessing old memories and using them in new situations. These changes would probably explain why ADD and ADHD are associated with sleep apnea in approximately 80% of children. This is in addition to the known harm from oxygen desaturation and fragmented sleep seen with sleep apnea. These changes in the brain are similar to the changes seen in the adult brain but are obviously much more dangerous in the developing brain. While this study may not be final proof of cause and effect can we afford to risk diminished IQ in our children or should aggressive diagnosis and treatment of sleep apnea in children immediately.
Development of the front cortex is more damaging in children but continues throughout the teen years. Final maturation occurs in the 30's. OSA affects approximately 2%of Children 4% of the population and up to 40% of men in their 40's and beyond. Heavy snoring has recently been shown to increase the risk of Carotid Atherosclerosis and stroke ten fold or 1000%. This was published in Sleep. September 2008.
Obstructive sleep apnea occurs due to partial or complete airway obstruction by the tongue and other soft tissues due to anatomic and/or neuromotor factors. The leading cause of sleep apnea in children is enlarged tonsils and adenoids, and the first line of treatment has been surgical removal. This is now being challenged by another form of Dental Sleep Medicine, early orthodontic expansion. A presentation at the American Academy of Dental Sleep Medicine meeting suggested that orthodontic expansion should precede tonsil and adenoid removal but that in most cases both procedures should be preformed. The speaker suggested that the earlier the airway obstructions are removed the better. Orthodontic expansion can be done at two years of age or even younger.
An article in Sleep, Orthodontic Expansion Treatment and Adenotonsillectomy in the Treatment of Obstructive Sleep Apnea in Prepubertal Children by Christian Guilleminault, et al showed that the majority of children benefited by surgical and orthodontic procedures and a small group benefited by orthodontic procedures alone. The impact of rapid maxillary expansion in children is not only an oral change but also a reduction in nasal resistance as well. The mouth and nose are similar to a two-story building. The roof of the mouth and the floor of the nose is the same structure and early expansion of the oral cavity also widen the nasal cavity leading to a lifetime of better breathing and probably increased intelligence, better health and better physical performance.
An article in Sleep, Orthodontic Expansion Treatment and Adenotonsillectomy in the Treatment of Obstructive Sleep Apnea in Prepubertal Children by Christian Guilleminault, et al showed that the majority of children benefited by surgical and orthodontic procedures and a small group benefited by orthodontic procedures alone. The impact of rapid maxillary expansion in children is not only an oral change but also a reduction in nasal resistance as well.
Dr. David Gozai, of the University of Chicago, showed with his team of sleep experts in a recent study, that kids in the bottom 10th percentile of class were more likely to snore and have sleep apnea than kids in the top percentile.
Dr. Owens cautions that removal of adenoids and tonsils is not the right treatment for everyone. Some snoring can be attributed to asthma or allergies, and some to obesity. Exercise and a good diet can help the latter. Dr Shapira notes that widening of the upper jaw (maxilla) is frequently needed in addition to removal of tonsils and/or adenoids. Children with allergies, enlarged tonsils or adenoids and snoring often have developmental changes take place in their jaws.
Whatever the cause, sleep apnea can cause dips in oxygen levels, and it goes without saying that a young developing brain needs oxygen to thrive.See http://www.ihatecpap.com for more information on treatment of sleep apnea and snoring in adults and children.
