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Questions and Answers About Sleep

Children with Sleep Apnea More Likely to Have Behavioral and Learning Problems

There have been multiple studies published in the last few years regarding the effects of obstructive sleep apnea (OSA) and other sleep disorders on children and teens.

In early 2013, Penn State researchers published the results of a study showing that children who have learning, attention and/or behavior problems may in fact be suffering from a condition known as excessive daytime sleepiness (EDS) — even if tests indicate that they are getting enough sleep at night.

In another study entitled Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years, published March 2012 in the Official Journal of the American Academy of Pediatrics, a researcher noted that cases of attention deficit hyperactivity disorder (ADHD) in children may have been misdiagnosed—that the cause of behavior such as moodiness and hyperactivity might have been due to OSA or other sleep disorder, which caused sleep deprivation in the child.

A new study adds to growing evidence showing the relationship between children with obstructive sleep apnea, and behavioral and learning problems.

The report entitled, Children with sleep apnea have higher risk of behavioral, adaptive and learning problems was published in the April issue of the journal, SLEEP.

The five-year study, which was led by Michelle Perfect, PhD, assistant professor in the school psychology program in the Department of Disability and Psychoeducational Studies at the University of Arizona in Tucson, found that OSA and sleep-disordered breathing is associated with increased rates of ADHD-like behavioral problems in children, as well as other adaptive and learning problems.

For the study …

The researchers examined the prevalence and incidence of sleep-disordered breathing and its effects on neurobehavioral functioning in 263 Hispanic and Caucasian children between the ages of 6 and 11.

The child patients completed an overnight sleep study, as well as a series of neurobehavioral assessments that included parent-and child-reported rating scales. This is the first sleep-related study to use a standardized questionnaire to assess adaptive functioning — the relative ability of a person to effectively care for one’s self and interact with society — in typically developing children, with and without sleep-disordered breathing problems.

Results of the study

  • 23 children had incident sleep apnea that developed during the five-year study period.
  • 21 children had persistent sleep apnea throughout the entire study.
  • 41 children, who initially had sleep apnea, did not show signs of breathing problems during sleep at the five-year follow-up.
  • The odds of having behavioral problems were four to five times higher and six times higher in children who had persistent sleep apnea.
  • Children with sleep apnea were also more likely to have parent-reported issues of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care, compared to children who never had sleep-disordered breathing problems.
  • Children with persistent sleep apnea were also seven times more likely to have parent-reported learning problems, and three times more likely to have school grades of C or lower.

According to Michelle Perfect, PhD, the study’s lead author, there are considerable behavioral risks associated with continued sleep-disordered breathing. "This study provides some helpful information for medical professionals consulting with parents about treatment options for children with sleep-disordered breathing.”

Perfect continued, "Even though SDB appears to decline into adolescence, taking a wait and see approach is risky and families and clinicians alike should identify potential treatments. School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom."

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