It's never too early to worry about sleep apnea.
A recent story from Reuters discusses a study that links preschoolers' snoring with behavior problems.
CPAP is mentioned as the snoring may be an indication of apnea, just as it is for adults.
It doesn't take an expert to realize small children who didn't get a good night's sleep will act out.
Same as adults, not all children who snore have apnea. But it's certainly a piece of the puzzle to investigate.
I pasted the Reuters story below, with the portions related to apnea and CPAP highlighted.
By Amy Norton
NEW YORK (Reuters Health) - Preschoolers who habitually snore may be
at greater risk of behavioral problems than other kids their age, a
study published Monday suggests.
Researchers found that two- and three-year-olds who snored loudly at
least a couple of times per week tended to have more problems with
inattention and hyperactivity.
More than one-third of those "persistent" snorers were considered to
be at least at risk of a behavioral disorder, like attention-deficit
hyperactivity disorder (ADHD).
That compared with 10 percent to 12 percent of their peers who either did not snore or had shorter-lived problems.
The study, published in the journal Pediatrics, adds to others that
have linked children's behavior to so-called sleep-disordered breathing -
when kids chronically snore, mouth-breathe or seem to stop breathing
for several seconds at a time as they sleep
(what doctors call "apnea").
The findings do not prove that the breathing problems directly lead
to behavioral problems - or that treating the underlying cause of
snoring can improve kids' behavior.
But they suggest that problem snoring is something parents and pediatricians should take seriously, according to lead researcher Dean Beebe, of Cincinnati Children's Hospital Medical Center.
"Kids are going to snore sometimes, especially when they have a
cold," Beebe said in an interview.
"It's when the snoring persists that
it gets concerning."
Chronic, loud snoring, he said, "should be on parents' radar, and it's something they should bring up to their pediatrician."
The American Academy of Pediatrics already recommends that pediatricians
ask parents about kids' snoring, in order to catch cases of
sleep-disordered breathing. But in real life, that may or may not
happen, Beebe said.
For many kids, especially three- to six-year-olds, loud snoring is
caused by enlarged tonsils or adenoids, and removing the tissue can
improve their ability to breathe at night.
Another treatment option is continuous positive airway pressure
(CPAP), which involves wearing a special mask that delivers steady air
pressure through the nose during sleep.
The current study does not say anything about whether such treatments prevent or ease behavior issues.
Beebe said some research has found that kids who get their enlarged tonsils and adenoids removed show behavior improvements.
But those studies were not controlled clinical trials, in which kids
would be randomly assigned to have the surgery or not. Those types of
studies are considered the "gold standard" in showing that a treatment
actually works.
"There is reason to believe that treatment might be helpful," Beebe said. "But we don't have the strong evidence we'd like."
There is, however, a clinical trial underway to test whether tonsil and adenoid surgery does help some kids' behavior problems.
The current study included 249 children who were followed from birth
to age three. Overall, nine percent were considered persistent snorers,
based on parents' reports. That meant they'd snored loudly at least
twice a week at the ages of both two and three.
Another 23 percent were "transient" snorers, meaning they'd snored at
least twice a week at either age two or three, but not both. The rest
of the children, 68 percent, were considered non-snorers.
Overall, 35 percent of the persistent snorers scored high enough on a
standard questionnaire to at least be considered "at risk" of a
behavioral disorder. That doesn't mean they had one, though.
"It's not necessarily diagnostic," Beebe said. "But they're showing more problems than is typical."
There is a possibility that parents who complain of snoring problems
are also more likely to complain about their kids' behavior, Beebe
acknowledged.
But if that were the case in this study, he said, you'd probably see
parents of transient snorers also report more behavior problems than
parents of non-snorers did.
"But that's not what we see," Beebe said. "It's only if they're snoring at both ages."
There are reasons to believe that sleep-disordered breathing would
affect children's behavior, according to Beebe. One reason is that poor
sleep quality could make kids tired and more easily frustrated.
One study, Beebe noted, found that "nap-deprived" preschoolers had a
tougher time with puzzles than their peers who got their nap.
And based on animal research, it's possible that when apnea causes
oxygen levels to go down repeatedly overnight, there might be effects on
the brain circuitry.
But there could also be other factors that explain the connection
between snoring and behavior problems. Beebe's team accounted for family
income, children's exposure to cigarette smoke and certain other
factors, and the snoring-behavior link still held.
But, Beebe said, with these types of studies, it's always possible that there are other explanations.
For now, he recommended that parents be aware that persistent snoring
is "not normal," and is something they should tell their pediatrician
about.
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