Despite the old adage, “sleeping like a baby,” we know that children are at risk for many of the same sleep disorders as adults. Sleep-disordered breathing is a problem among children—even very young children. This news reveals some of the negative consequences of untreated sleep-disordered breathing in children. In a study of the sleep, breathing and behavioral development of more than 11,000 children, researchers at Yeshiva University’s Albert Einstein College of Medicine have found that those children with sleep disordered breathing were more likely to develop behavioral problems and emotional problems, and also to have greater difficulty with peer relationships. Researchers relied on information gathered from parent questionnaires. Parents answered questions about their children’s sleep and breathing, starting from the time their children were 6 months old, and repeating regularly until their children were nearly 7 years old. Parents also provided information about their children’s behavioral and emotional development, in questionnaires given when children were 4 years old, and again at age 7. The behavioral and emotional development issues addressed included:
- Anxiety and depression
- Problems with peers
- Conduct issues, including aggressiveness and rule breaking
- Positive social behaviors, including sharing and helpfulness
Researchers found that children with sleep-disordered breathing were significantly more likely to have behavioral and emotional problems than children without disordered breathing.
- Children with sleep-disordered breathing were 40 to 100% more likely to have behavioral problems by the age of one year
- Hyperactivity was the behavioral issue that increased the most with disordered breathing, but all behavioral problems showed significant increase
- Children with the most severe behavioral problems also had the most persistent sleep-disordered breathing throughout the 6-year evaluation period
The results of this large-scale study provide strong evidence of a link between sleep-disordered breathing and behavioral problems. But these results don’t tell us why sleep-disordered breathing is likely to be affecting children’s behavior and emotional development. The scientists who conducted the study believe that several factors may be involved. These factors include:
- Decreased oxygen (and increased carbon dioxide) to the child’s brain during periods of breathing-disordered sleep
- A lack of restorative sleep
- Changes to body chemistry and cell development as a result of sleep deprivation and/or the disordered breathing itself
It’s actually a group of conditions, each of which interrupt or diminish airflow. Sleep-disordered breathing conditions include snoring, mouth breathing, and sleep apnea. These may seem like issues for adults only, but in fact they’re all-too-common problems for children as young as toddlers, and even younger. This recent study found sleep-disordered breathing in children as young as six months. Observing children ages 6 months to 6.75 years, the study found:
- Chronic sleep apnea among 1-2% of children at all age levels
- “Habitual” snoring among as many as 21% of children
- An increase in the frequency of snoring in children between the ages of 1.5 and 2.5 years
- Mouth breathing in 25% of children by the age of 6
Recent research, including this latest study, is giving us a clearer picture of the negative effects of sleep-disordered breathing and poor sleep on child development and behavior. Other recent research has shown:
- Children who exhibit aggressive behavior at school are twice as likely to have a sleep-disordered breathing condition as children who don’t show aggressive behavior.
- Children with sleep-disordered breathing are more likely to have cognitive deficits compared to children without breathing disorders. These deficits existed regardless of the degree of severity of the breathing problem.
- By the time kids reach adolescence, sleep problems are associated with a long and troubling list of risky and unhealthful behaviors, including fighting, smoking cigarettes and marijuana, drinking alcohol, and coping with feelings of sadness, hopelessness and suicide.
This is a critically important area of study that needs more attention. The more we know about how sleep-disordered breathing affects children’s behavioral, emotional and intellectual development, the better we’ll be at stepping in to treat and prevent the problem before it becomes serious. As parents, there are some basic, and important, steps you can take to help protect and improve your children’s sleep:
- Set a sleep schedule and stick to it. Regular bedtimes, and nighttime routines that help a child prepare for bed, are a critical part of helping our kids develop strong sleep habits.
- Make their bedrooms sleep friendly. I can’t say this enough: keep the electronics out of the bedroom. Kids’ bedrooms should be dark, quiet places for rest—not a haven for television, video games, laptops and cell phones.
- Talk to you doctor. Make sleep a regular part of the conversation with your child’s physician. Get specific—ask your pediatrician about sleep-disordered breathing, and what steps to take if your child is exhibiting symptoms.
Sleep-disordered breathing in children, no matter how mild it appears, should never be ignored. By addressing these issues before they become serious, we can help keep our kids sleeping well and growing well.
Michael J. Breus, PhD
The Sleep Doctor™