Snoring in children could indicate serious future health complications

As the director of Johns Hopkins University Pediatric Sleep Center, Dr. Carole Marcus warns, "Parents should be aware that snoring is not necessarily a normal phenomenon for their children, and they should discuss it with their doctors." Dr. Marcus is the chairwoman of the American Academy of Pediatrics subcommittee that produced a set of guidelines to deal with the potential problems of snoring in youth.

Experts are concerned that snoring in children is an indicator of obstructive sleep apnea syndrome, an often overlooked problem in two percent of children that is strongly linked with learning disabilities, bed wetting, slow growth and development, and even cardiorespiratory problems like high blood pressure.

Snoring is a possible precursor of future medical hindrance to children's development. The American Academy of Pediatrics published their guidelines in the April issue of Pediatrics, the academy's medical journal.

The guidelines encourage parents to report occurrences of snoring during the regular checkups of children, which can be alleviated by the extraction of tonsils and adenoids via surgery. The entire procedure is simply a precaution to one of the most common symptoms of obstructive sleep apnea, there are still chances that the child could be unaffected by snoring. Nevertheless, studies show that around half a million children from tender ages of two to eight are affected. Sleep experts expect that the estimate is lower than actuality because snoring is often ignored as a mere undesirable habit.

The number of children who are affected can be treated at an early stage before the syndrome develops into a life-threatening problem.

Dr. Marcus points out, "I don't think [obstructive sleep apnea syndrome] is on the rise, but it was ignored a lot in the past. If you look at the 1960s and 1970s, these children weren't diagnosed until they came in with a coma or heart failure. One of the big things about these guidelines is that we're recommending objective testing and not to make a decision to treat based on history."

Dr. Marcus also believes that physicians have the responsibility of following up on current medical discoveries and updating their treatments of patients accordingly.

"It has become apparent that [physicians] are doing very different things and not keeping up with the literature and not doing the best management," Dr. Marcus comments.

Dr. Raouf Amin, associate professor of pediatrics and director of the Sleep Disorders Clinic at Cincinnati Children's Hospital Medical Center, concurs with Dr. Marcus, "The condition is underrecognized. Quite frequently, general pediatricians don't ask detailed questions about sleep apnea and general sleep disorders, so these guidelines would make pediatrician more aware of the syndrome and what are the things that they need to use in order to screen for this type of abnormality."

Stephen Sheldon, a sleep specialist at Children's Memorial Hospital in Chicago, acclaims the guidelines as "a tremendous step forward" to make less mistakes on diagnosis of child disorders. Disorders are finally becoming common knowledge; Sheldon claims, the correct association between snoring and obstructive sleep apnea syndrome "really have gone unrecognized, until now."

During sleep, symptoms of obstructive sleep apnea are in a combination of snoring, enlarged tonsils and adenoids, relaxation or reduced muscle tone in the upper airway. Immediate effects such as tiredness during awaking hours could be related to the hard, noisy breathing coupled with irregular intervals of breathing while asleep.

Results in the child are observed as restlessness, rowdy behavior and brief learning attention span for learning. These disruptive neurobehavioral problems may lead to misdiagnoses of attention deficit disorder and slow physical growth. For the body to continue supplying the fuel for the engine of the body, the body adapts to a new way of breathing, which is with the mouth. Many affected children exhibit nasal-sounding voices or open-mouth breathing. Long-term risks include obesity, craniofacial anomalies and neuromuscular disorders.

An adenotonsillectomy, surgery to remove both the tonsils and adenoids, advances the health of the child; the child's learning abilities enhances, growth spurt jumps in and snoring discontinues. Dr. Marcus reassures that after surgery, symptoms will fade away.

"In otherwise healthy children, [adenotonsillectomy] will cure about 95 percent of them," Dr. Marcus says.

Continuous positive airway pressure (CPAP) is an alternative method of treatment for children who cannot undergo surgery.

"Children who have other underlying conditions might need further therapy," Marcus says. CPAP pumps continuous air pressure through a nasal mask worn during sleep. Unlike an adenotonsillectomy, which solves the problem directly, CPAP has to be worn until it is safe to stop, and it needs the child's full cooperation.