Entries in Snoring (4)


AAP Issues New Guidelines for Kids’ Snoring

Hemera/Thinkstock(NEW YORK) -- A new set of practice guidelines released Monday by the American Academy of Pediatrics (AAP) may help parents and pediatricians identify and diagnose kids who snore.

Pediatric sleep experts focused on children with a condition known as uncomplicated obstructive sleep apnea, which occurs when breathing is interrupted during sleep and is related to enlarged tonsils or obesity.  It is a condition the AAP says affects 1.2 to 5.7 percent of American children.  They reviewed evidence from 350 study articles between 1999 and 2010 to create the following recommendations:

  • Screening: All children and adolescents should be screened for snoring at their routine health visits.
  • Sleep testing: Any children who have symptoms of obstructive sleep apnea, such as habitual snoring, disturbed sleep from intermittent pauses, snorts or gasps, or daytime behavioral problems, should be referred for a sleep study.
  • Adenotonsillectomy: Any child with obstructive sleep apnea and enlarged tonsils should be referred to a surgeon to consider tonsil removal surgery.
  • High risk: A child undergoing tonsil surgery is considered “high-risk” if he or she is under age 3, has severe sleep apnea on sleep testing, is obese or currently has an infection.  These children should be closely monitored in the hospital after surgery for any complications.
  • Re-evaluation: After surgery, snoring children should be reassessed to see if their sleep apnea has improved or if they will need any further treatments.
  • CPAP: If symptoms do not improve after surgery or if a child is unable to get surgery for some reason, they should be considered for CPAP (continuous positive airway pressure), which is a breathing apparatus, often worn at night, that keeps airways open.
  • Weight loss: Weight loss is recommended for any overweight or obese patient in addition to any other treatments.
  • Intranasal steroids: Nasal sprays are recommended for patients with mild sleep apnea symptoms, whether in lieu of or after tonsil surgery.

The last set of guidelines for pediatric sleep apnea was released in 2002.  The changes reflected in these new guidelines were made in light of research over the past 10 years that has suggested that delayed diagnosis of childhood sleep apnea “can result in severe complications if left untreated,” according to the American Academy of Pediatrics report.  Examples include cognitive deficits, behavior problems, hypertension and heart problems, failure to thrive and inflammation throughout the body.

With these new guidelines, the AAP hopes that more cases of childhood sleep apnea will be diagnosed sooner and children will receive the proper treatments earlier to prevent these dangerous long-term effects.

Copyright 2012 ABC News Radio


Loud, Persistent Snoring in Toddlers May Be Cause for Alarm

Hemera/Thinkstock(CINCINNATI) -- Aside from being a nocturnal annoyance, a new study confirms snoring in young kids can have implications for their behavior later on.

Previous research has shown that poor sleep quality in children, including snoring, is linked to hyperactivity.  However, little is known about "how much" snoring is too much, and whether the behavioral effects last over time.

The link between snoring and effects on behavior may be related to hypoxia, or decreased oxygen delivery to the brain.  Snoring may be a sign that not enough air is going through a person's airway -- a situation many doctors believe occurs frequently with sleep-disruptive breathing disorders.  Less oxygen delivery to the brain can mean inflammation, and even changes in the brain tissue itself.

"Many preschool children snore for brief periods, [for example] when they have a cold," says Dean Beebe, a neuropsychologist at Cincinnati Children's Hospital Medical Center.  "But loud snoring that lasts for months or years is abnormal and may signal a sleep-related breathing problem that could affect a child's behaviors during the day."

Beebe and colleagues explored these issues in a new study published Monday in the journal Pediatrics.  Their goal was to focus on younger children and "follow kids over time to get a sense of what happens when snoring persists," he says.

Researchers looked at 249 mother/child pairs at 2 and 3 years of age and asked parents how frequently they heard "loud snoring" coming from their child's bedroom.  Children were characterized as "non-snorers" if they snored less than once per week, "transient snorers" if they snored more than two times per week at age 2 or age 3, or "persistent snorers" if they snored more than two times per week both at age 2 and at age 3.

The same children were also assessed for behavioral problems -- including hyperactivity, aggression, depression and inattention -- based on a validated questionnaire known as the Behavior Assessment System for Children.

The results of this study demonstrated that the persistent snorers had significantly worse overall behavioral functioning at age 3, specifically in the areas of hyperactivity, depression and attention, compared to the transient snorers and the non-snorers.  In fact, 35 percent of persistent snorers were found to be at risk for behavioral problems.

Pediatric sleep specialists say they are enthused by the findings.

"In my opinion, this study is very important," states Dr. Frisca Yan-Go, a neurologist from UCLA, "because it gives data to support clinicians in emphasizing that habitual snoring is not normal at any age."

Yan-Go explains that if a sleep-related breathing disorder disrupts a child's sleep, "[It] definitely will affect the child's daytime function, including behavior, learning and development."

Sleep experts say parents who have kids who snore loudly and persistently should inform their pediatricians as soon as they can.

Copyright 2012 ABC News Radio


Snoring Babies May Become Hyperactive Kids, Study Finds

Comstock/Thinkstock(NEW YORK) -- The quality of sleep children get, including how much they snore as a baby, may affect their risk of growing into hyperactive kids down the line, suggests a new study.

The findings, published Monday in the journal Pediatrics, could resonate with parents of the more than five million American children who are currently diagnosed with attention deficit hyperactivity disorder, or ADHD.

Conducted in England as part of the Avon Longitudinal Study of Parents and Children, investigators looked at more than 11,000 children from birth to age 7.  Sleep questionnaires were distributed to parents at six different time points.  In particular, the researchers looked for evidence of sleep-disordered breathing, which is characterized by snoring, mouth-breathing or not breathing at all for a few seconds, a condition known as apnea.

To assess the behavior of these children, the researchers administered a test known as the Strengths and Difficulties Questionnaire (SDQ) at ages 4 and 7.  Those with higher sleep-disordered breathing scores in infancy and/or early childhood displayed significantly more behavior problems at ages 4 and 7.  By age 7, the high snorers were more than 1.5 times as likely as their soundly sleeping peers to show hyperactivity.

Other issues linked to troublesome breathing during sleep were emotional disturbance (depression and anxiety) and aggressive, combative conduct.

Pediatricians contacted by ABC News see these results borne out by their clinical experience.

"As a general pediatrician, I come across problems related to sleep-disordered breathing every day," said Dr. Stephen Lauer, vice chairman and associate professor of pediatrics at Kansas University Medical Center.  "When there are issues of behavioral problems, school performance and especially ADHD concerns, the first question I ask has to do with sleep and snoring."

This study alone, however, cannot prove that sleep-related breathing problems are the root cause of the behavioral issues.  Lead author Karen Bonuck, researcher at Albert Einstein College of Medicine in New York, said that despite the "strong and persistent association between the symptoms and the outcome... [t]here is always the potential in epidemiologic research that there are characteristics that aren't accounted for."

Even factors the researchers accounted for in their work may have exerted an unseen influence.  Prematurity, smoking during pregnancy and lower socioeconomic status -- each individually associated with childhood behavioral troubles -- were seen more among the problem sleepers, which brings up the possibility of an as-yet-unknown uniting cause.

Copyright 2012 ABC News Radio


CPAP Mask Treats Sleep Apnea, Heart Problems

Siri Stafford/Digital Vision/Thinkstock(NEW YORK) -- Joan Siegel reached the tipping point of husband Alan's snoring on their trip to China.

For the past three years, Siegel could bear her husband's snoring and waking in the middle of the night. It was simple: just sleep peacefully in another bedroom.

But when she found herself stuck in the same hotel room on their big trip, there was no escape.

"She told me she'd never go on vacation with me again unless I got help," said Siegel, 61 of Jericho, N.Y. "She really meant it and that did it for me."

Siegel suffered from obstructive sleep apnea, a condition in which Siegel's blocked airways caused him to stop breathing in the middle of the night. For many patients with sleep apnea, each pause in breathing typically lasts 10 to 20 seconds or more, and the pauses can occur 20 to 30 times or more an hour, according to the American Sleep Association.

If left untreated, sleep apnea can lead to high blood pressure, heart disease, obesity and stroke. "I was getting tired during the day," Siegel said. "Let's just say I needed a lot of coffee."

After his diagnosis, Siegel's specialist, Dr. Lisa Liberatore, recommended a continuous positive airway pressure mask (CPAP), a device worn while sleeping to open the airways and keeps the oxygen flowing.

It's considered the gold-standard treatment for sleep apnea, but the mask can be a source of disdain for many patients who are advised to wear it. It can be irritating, itchy, loud and, for some, can lead to headaches.

But there's a reason it's the first-line treatment for sleep apnea. A new study suggests only three months of CPAP therapy can dramatically lower blood pressure and decrease the risk and even treat signs that can lead to metabolic disorders such as heart disease and diabetes.

Eighty-six patients with moderate to severe sleep apnea were randomly assigned to undergo standard CPAP therapy or a sham CPAP therapy, according to the study that was published Wednesday in the New England Journal of Medicine. Eighty-seven percent of the group already had signs of a metabolic disorder at the start of the study.

After three months, 20 percent of patients who completed CPAP therapy for the first time were more likely to have lower blood pressure, lower cholesterol and a lower body mass index (BMI), compared to those on the false therapy. A lower BMI and smaller waistline may have been the result of participants' being less likely to fall asleep during the daytime and therefore more physically active, the researchers said.

Patients who wore the CPAP mask for five or more hours a night were also more likely to see the most improvement in their overall health.

Still, the stigma of sleeping with a large ventilated mask holds many patients back from even trying the treatment. "It's not the most attractive for couples," said Liberatore, otolaryngoloist at Lenox Hill Hospital in New York. "Sometimes, they feel like they're choking."

But there are many models of the mask. And Siegel chose one he said was smaller and less intrusive.

The initial fitting trial with CPAP offers some the best sleep they've had in a long time, and that will win them over, Liberatore said.

Alternatives to CPAP therapy include surgery to clear the obstructive airways. But Liberatore says surgery is the last resort, and some patients, depending on the reasons causing their sleep apnea, might not qualify.

The overall goal for many patients is to lose the weight that might be bringing on the sleep apnea, Liberatore said. Sleep disruption caused by sleep apnea and the lack of oxygen to vital organs can cause changes in hormones involved in appetite regulation and fat retention.

Siegel, who exercises regularly and is not considered overweight, says other parts of his health have improved dramatically. After two months, Siegel no longer snores, sleeps through the night, and feels more energized during the day. What's better, he says, is that is wife is happy.

Copyright 2011 ABC News Radio

ABC News Radio