Snoring Toddlers May Have More Behavior Problems

But breast-feeding helped protect against snoring in youngsters, study found

Monday, August 13, 2012

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MONDAY, Aug. 13 (HealthDay News) -- Toddlers who snore persistently are more likely to have behavior problems, such as hyperactivity, depression and attention issues, during the day than their non-snoring peers, new research indicates.

The study also looked at factors that might contribute to or protect against snoring in this young age group, and they found one was strongly protective: breast-feeding. Factors that made persistent snoring more likely included low socioeconomic status, race and exposure to environmental smoke, said study author Dean Beebe, director of the neuropsychology program at Cincinnati Children's Hospital Medical Center.

"Snoring is cute in comics or cartoons, but in reality it's not normal for kids to snore for weeks or months on end," said Beebe, who is also an associate professor of pediatrics.

"Snoring can disrupt the quality of sleep, and a tired toddler has a much lower tolerance for frustration. When you add chronicity to the problem, over time, that lack of sleep sets up negative interactions within the toddler's environment, which may change the way they respond," Beebe explained. "This is a developing brain. The connections that are made and retained are about their experiences. A lack of sleep could fundamentally alter those experiences."

Results of the study were published online Aug. 13 and in the September print issue of Pediatrics.
Beebe's study included 249 children who were involved in a prospective study that followed the children's health from birth. Their mothers let the researchers know how often the children snored when they were 2 and again when they were 3.

Of participants, 170 children were non-snorers. Their mothers said they rarely snored at either age. Fifty-seven children were transient snorers. Their mothers reported loud snoring more than twice a week either when they were 2 or 3, but not at both times. The snorers were the smallest group. Just 22 youngsters snored more than twice a week when they were 2 and were still snoring that much when they were 3.

Children who were persistent snorers were more likely to have been exposed to environmental tobacco smoke prenatally and into childhood. Snorers were significantly more likely to be black and to have a low socioeconomic status, according to the study.

The researchers didn't find any differences in motor development between snorers and non-snorers or transient snorers, but they did find that snorers were more likely to be hyperactive, depressed or inattentive.
Dr. Sangeeta Chakravorty, director of the pediatric sleep evaluation center at Children's Hospital of Pittsburgh, wasn't surprised by the findings. "Snoring impacts sleep, and sleep loss impacts behaviors," she explained.

But, she noted that the study wasn't able to determine whether the behavior problems were just because the children were tired, or if their snoring was significant enough to cause a chronic lack of oxygen, because the study only included information from the children's mothers. There were no objective data, such as oxygen levels throughout the night.

Chakravorty added that snoring in this age group is actually common. She said enlargement of the adenoids was the biggest cause of snoring, followed by enlarged tonsils. Nasal allergies can also cause snoring, as can abnormalities in the facial structure or the structure of the airway. And obesity can cause snoring in children like it does in adults.

Both experts recommended bringing up any persistent snoring with your child's pediatrician. "If you hear your child snoring more than three to four times a week in the absence of an upper respiratory infection [cold], and it lasts more than a month, seek help from the pediatrician," Chakravorty said.

"There are treatments for snoring," said Beebe, who cautioned that parents should be prepared for the possibility that treating the snoring may not always cure the behavior problems. "Snoring may or may not be the cause of behavior problems," he said.

While the study found an association between toddler snoring and behavior problems, it did not prove a cause-and-effect relationship.

SOURCES: Dean Beebe, Ph.D., associate professor, pediatrics, and director, neuropsychology program, Cincinnati Children's Hospital Medical Center, Ohio; Sangeeta Chakravorty, M.D., director, pediatric sleep evaluation center, Children's Hospital of Pittsburgh; September 2012 Pediatrics

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