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Primary Snoring Linked to Neurobehavioral Problems in Children: Presented at ATS

By Charlene Laino

SEATTLE, WA -- May 19, 2003 -- Children who snore are more likely to have neurobehavioral deficits than those who do not, a new study shows.

Louise O'Brien, PhD, a research fellow at the University of Louisville in Kentucky, United States, presented the findings here on May 18^th at the American Thoracic Society International Conference.

Previous studies have shown that children who snore have problems such as hyperactivity, but those studies did not differentiate between children who have obstructive sleep apnea (OSA) and those who do not.

To find out if primary snoring in the absence of OSA was a risk factor for behavioral and psychological problems, O'Brien's team decided to study a community-based sample of young children.

The researchers sent out detailed sleep questionnaires to parents of five- to seven-year-old children in public schools in the Louisville area. If parents reported that their children almost always or frequently snored, the children were invited for overnight polysomnography and a battery of neurobehavioral tests.

The final cohort included 87 youngsters, ages 5 to 7 years, who snored and in whom OSA was ruled out and 31 controls who did not snore. The mean age (6.6 years vs. 6.8 years), the percentage of boys (51% vs. 58%) and the percentage of parents with a college education or higher (64% vs. 74%) were similar in both groups.

All the parents filled out the Conners Parent Rating Scale, which gauges such factors as hyperactivity and attention span, and the Child Behavior Check List, which looks for symptoms of anxiety.

The children were administered the Differential Ability Scale (DAS), which measures reasoning skills and conceptual ability, and the "NEPSY" neuropsychology test that measures the ability to plan and execute tasks as well as language and visual abilities and memory.

The children who snored performed worse on just about every measure than those who did not, O'Brien reported. "While their scores were still within the normal range, they were more hyperactive, more impulsive and had more social problems. And they were more anxious and depressed than children who didn't snore."

The biggest differences were seen on the cognitive test scores, she said, with children who snored having significantly worse verbal, language, and spatial skills than the nonsnorers. For example, children who snored had a DAS score of 97.9 compared with a score of 105.5 in nonsnorers (100 being normal). And their verbal/spatial skills were a median of 103.1 versus 107.7 for nonsnorers (P<0.001)

While the study was not designed to determine why snoring leads to psychological problems and learning deficiencies, the researchers speculated that sleep fragmentation and intermittent hypoxemia might be to blame.

The findings suggests that current guidelines for the management of snoring may need to be reevaluated, said Dr. O'Brien, noting that the American Academy of Pediatrics says that snoring in the absence of OSA should be considered a benign condition.

"Right now, you can't find guidance on how to manage the child who snores," she said. "We need to find a way to determine which kids who snore are vulnerable to neuropsychological problems."

[Study title: Do Children with Sleep Disordered Breathing Have Altered Autonomic Nervous System Function? Abstract 420]

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