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Baby breathing disorders may cause long-term behavioral problems

by Rian Ervin
March 06, 2012


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Infants needs to sleep soundly as their rapidly growing brains develop. Snoring or other disordered breathing when they sleep should be an indication to check in with a pediatrician.

A snoring baby may look cute, but the sound means losing critical benefits of a deep sleep.

Babies who have unnatural breathing patterns while sleeping may develop long-term emotional and behavioral problems, report researchers from the Albert Einstein College of Medicine in New York.

During the early months of life when sleep is critical to brain development in infants, disrupted sleep may prevent the brain from growing as it should.

“You can pretty accurately predict at a young age whether or not children will have behavioral problems,” said Karen Bonuck, a professor at Albert Einstein College of Medicine who analyzed data from the study.

Sleep disordered breathing - defined in the study as snoring, mouth breathing and sleep apnea - duirng infancy was associated with a 20-60 percent chance of increased behavioral difficulties at age 4 and a 40-100 percent likelihood at age 7.

For the study, parents of more than 11,000 children periodically observed their child’s sleep patterns from 6 months until age 7. To determine association with behavior problems, researchers used a screening tool, which was administered by parents when children were 4 and 7.

The screening questionnaire “can identify behavioral problems consistent with a clinical diagnosis,”   Bonuck said.

Due to the large size of the study, researchers were able to control for other variables that can be linked to behavioral problems in youth. Some of those include being male, maternal education level and financial status.

Even controlling for these other factors, however, sleep disordered breathing still had the strongest association with development of behavioral issues such as hyperactivity or difficutlies with peer interaction.

An association between sleep disordered breathing and behavioral problems has been well documented, said Dr. Stephen Sheldon, director of the Sleep Medicine Center at Children’s Memorial Hospital and professor of pediatrics at Northwestern University’s Feinberg School of Medicine.

“This is a huge study, which makes the data very reliable,” he said.

“We knew that sleep disordered breathing would have some association with emotional problems, but what we didn’t expect was that in such a big study, even taking in the factors we could control for, sleep disordered breathing still had the strongest effect,” said Bonuck.

Based on the prevalence of sleep disordered breathing early in life, researchers were able to accurately tell whether or not a child would develop problematic behavior.

“Multiple research studies from different researchers has shown that obstructive sleep apnea and even snoring can lead to behavioral issues, including changes in memory, concentration and mood,” said Dr. Leila Kheirandish-Gozal, associate professor of pediatrics and director of clinical pediatric sleep research at the University of Chicago.

Children with disrupted sleep can experience depression or withdrawal, or can turn towards aggressive and inattentive behavior, she said.

“The reason children have behavioral outcomes is multifactorial, but sleep disordered breathing is a big connection to it,” Bonuck said.

Since the brain is still evolving, and given the amount of time newborns spend sleeping each day, that time should be spent in a restorative process, Bonuck said. If that sleep is disrupted, it can mess with the development process.

“There is no clear cut mechanism identified yet as to why this happens,” said Kheirandish-Gozal. A child may not physically wake up, but the brain can arouse multiple times. “This results in a lack of quality sleep that has a major impact on the child’s brain function,” she said.

Bonuck said that it is important for parents to pay close attention to breathing while their children are sleeping, but to not be alarmed if they observe unnatural breathing.

“The symptoms that really need to be paid attention to are snoring and restless sleep,” said Sheldon. Other symptoms include gasping, snorting, moving around, waking up and sweating, he said.

“I think that parents are not so knowledgeable at this point,” said Bonuck. “Doctors may be somewhat more knowledgeable, but they don’t always ask the right questions.” Keep checking in with a physician and stay on top of your child’s sleep habits, she said.