Your child's snoring could harm their IQ: Obstructive sleep apnoea can hinder development
22:29 GMT, 16 July 2012
Carly Redwood was watching TV when she heard a rumbling noise from upstairs. ‘It was drowning out the TV,’ says Carly, a 36-year-old PA, who lives with her husband Dan, 36, a retail manager, in Farnham, Surrey.
‘When I listened harder I realised it was actually loud snoring and snorting.’
But it wasn’t Dan making all the racket, but the couple’s son Jack, who was just three at the time.
Breathing problem: Carly Redwood and
her son Jack
‘The sound was unbelievable — I was aghast that a toddler so small could snore like that,’ says Carly.
‘At night, it sounded as if he had a mask on or was being smothered, and it continued on and off until morning.’
Then in March, 14 months after the heavy snoring started, Carly noticed that Jack was repeatedly stopping breathing in his sleep for several seconds at a time, restarting with a gasp for air.
‘The next few nights I’d go into his room to check on him and he’d do it again and again — and I started to worry,’ she says.
All children snore at some time, however around one in ten snores regularly, and it’s a source of worry for many parents, says Marianne Davey, founder of the British Snoring and Sleep Apnoea Association.
‘About one in ten of the calls for help we receive are from parents about snoring children — and it is an increasing problem,’ she says.
Snoring is caused when the muscles in the airways relax, then vibrate when air flows past them. Other floppy tissue in the throat, such as the tonsils, can also add to the noise.
For most children, snoring isn’t a problem apart from keeping other family members awake ‘as they can make an awful lot of noise’, says Andrew McCombe, ear, nose and throat surgeon at Frimley Park Hospital, Surrey, and spokesman for ENT UK.
Common causes are sleeping on the back, a cold, allergy or being overweight.
But for around 2 to 3 per cent of children who snore (an estimated 350,000 youngsters), this is one of the first symptoms of a more serious condition called obstructive sleep apnoea.
This is the medical name for a pause in breathing while sleeping due to obstruction of the airways, which prevents air from travelling to and from the lungs.
While most people will have heard of it affecting adults, it also occurs in children. Children with sleep apnoea will snore loudly, have laboured breathing and then go silent for a few seconds, before snorting and gasping for air when they restart breathing.
These pauses in breathing cause oxygen levels in the blood to fall, and vital organs including the brain and the heart are affected.
Sleep apnoea in adults is linked to high blood pressure, heart disease and stroke, and in children it has similarly troubling consequences, including poor growth, delayed development, behavioural problems, impaired academic performance and reduced concentration. These are in part thought to be due to a lack of oxygen to the brain and other organs.
Parents may also notice children sleeping in unusual positions that make it easier for them to breathe, such as their head hanging over the side of the bed.
Unbelievable! Jack's snoring sounded like he was being smothered, says his mum Carly (posed by model)
And because these breathing problems can cause them to wake briefly several times a night, in the morning they may be grumpy, in some cases, have a headache (thought to be caused by a lack of oxygen during the night), or refuse to eat breakfast.
Worryingly, the condition often goes undiagnosed.
‘Some children can wait a long time for treatment,’ says Warren Lenney, professor of respiratory child health at Keele University and honorary medical adviser at the British Lung Foundation.
‘This can be attributed to the more subtle symptoms in children as well as the comparatively low awareness of the condition among the public and healthcare professionals. But it’s really important children get diagnosed and treated, especially as we know that it can affect their IQ and performance at school.’
A study carried out at the Melbourne Sleep Centre in Australia found cognitive differences between sleep apnoea sufferers aged seven to 12 and a control group without sleep problems.
The authors said prolonged sleep apnoea over several years affected a child’s IQ and education, as well as being associated with behavioural problems and poor memory.
And recently research based on 11,000 children in Britain found sleep apnoea and snoring made conditions such as hyperactivity more likely.
The theory is that because these children find it hard to concentrate they become more disruptive. All children will stop breathing for short periods in their sleep, says Mr McCombe, but this happens only once or twice a night and doesn’t cause any problems.
‘In sleep apnoea a child will stop breathing around ten times an hour or more (though it can be fewer). If this happens between 15 and 20 times a night it can cause these problems,’ he says.
While obesity is the most common cause of sleep apnoea in adults, the prime culprit for children — accounting for four in every five cases — is enlarged tonsils or adenoids, small lumps of lymph tissue at the back of the nose.
Other causes include structural abnormalities of the airways, such as receding jaw, Down’s syndrome (due to a large tongue) and obesity (which is the most common cause in adults).
The good news is that the effects can be reversed, says Dr Ranjan Suri, paediatric respiratory consultant at Great Ormond Street Hospital and the private Portland Hospital, both in London.
‘Often we find that once the sleep apnoea is sorted out, the child’s academic performance improves, too.’
He adds that the condition can be diagnosed only with an overnight sleep test in a sleep laboratory or at home — where heart rate, breathing patterns and blood oxygen and carbon dioxide levels are monitored with equipment.
Impact: Children with sleep apnoea may find it harder to concentrate
This is done via monitors fitted to the finger and chest and tubes inserted into the nose.
Treatment options include removal of the tonsils and adenoids (adeno-tonsillectomy), nasal drops that shrink the tiny blood vessels in the lining of the nose, losing weight if necessary or wearing a mask overnight to keep the airways open — though these are not always suitable for young children.
Mr McCombe says around 20 per cent of the 29,558 tonsillectomies performed on children in Britain in 2010/11 were done for sleep apnoea — the remainder were for repeated bouts of tonsillitis.
When Jack started to act out of character, Carly went to her GP.
‘Jack was tired during the day and falling asleep at nursery. In the mornings he’d complain that his head hurt and he seemed groggy and tired,’ she says.
His VOICE had changed, too, and become very nasal. Friends and family even nicknamed him Darth Vader because of his heavy breathing.
Though she had previously gone to the GP when Jack started snoring, Carly was told he would grow out of the condition. However, this time her GP referred him to an ear, nose and throat surgeon.
An overnight sleep study to monitor and measure Jack’s oxygen levels revealed he was stopping breathing eight times every hour.
The specialist classed Jack as having mild sleep apnoea and said the family could wait to see if he outgrew it or have his tonsils and adenoids removed straight away.
‘We decided to have it done straight away as we didn’t want him to suffer any more,’ says Carly.
The one-hour operation was done under a general anaesthetic. ‘The surgeon said afterwards that Jack had whopper tonsils and adenoids — so we were glad he’d had them taken out.’
Jack’s father, Dan, had large adenoids as a child and he, too, had them removed because of his loud snoring.
Within just a few weeks Jack’s breathing and sleeping had been transformed.
‘He’s so much happier, his voice is normal again and he’s not constantly tired,’ says Carly.
‘I’m so glad we pursued this and got his sleep apnoea sorted before he starts school in September.
‘People sometimes treat snoring as a joke, but it can be a sign of something far more serious.’
blf.org.uk/sleep or call the BLF helpline on 03000 030 555.