Tag Archives: Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years

Another study: Sleep problems can lead to behavior problems in children

30 Mar

In Albert Einstein School of Medicine study: Abnormal breathing during sleep can lead to behavior problems in children examined behavior issues of children with sleep problems.

Albert Einstein School of Medicine announced the study, “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.”

A study of more than 11,000 children followed for over six years has found that young children with sleep-disordered breathing are prone to developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships, according to researchers at Albert Einstein College of Medicine of Yeshiva University. Their study, the largest and most comprehensive of its kind, published online today…

Citation:

Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years

Pediatrics

Karen Bonuck, PhDa, Katherine Freeman, DrPHb, Ronald D. Chervin, MD, MSc, and Linzhi Xu, PhDa

  1. 1.    Published online March 5, 2012(doi: 10.1542/peds.2011-1402)

  2. » AbstractFree

  3. Full Text (PDF)

  4. Supplemental Information

https://drwilda.wordpress.com/tag/sleep-disordered-breathing-in-a-population-based-cohort-behavioral-outcomes-at-4-and-7-years/

A study by Michelle M. Perfect, Kristen Archbold, James L. Goodwin, Deborah Levine-Donnerstein, and Stuart F. Quan is in accord with the Albert Einstein study.

Science Daily reports in the article, Children With Sleep Apnea Have Higher Risk of Behavioral, Adaptive and Learning Problems:

Mar. 29, 2013 — A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioral problems in children as well as other adaptive and learning problems.

http://www.sciencedaily.com/releases/2013/03/130329161243.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily%2Ftop_news+%28ScienceDaily%3A+Top+News%29&utm_content=FaceBook

Here is the press release from the American Academy of Sleep Medicine:

Children with sleep apnea have higher risk of behavioral, adaptive and learning problems

American Academy of Sleep Medicine
Friday, March 29, 2013

EMBARGOED FOR RELEASE: 3 p.m. EDT, March 29, 2013
Contact: Lynn Celmer, lcelmer@aasmnet.org, 630-737-9700

DARIEN, IL – A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioral problems in children as well as other adaptive and learning problems.

“This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB,” said Michelle Perfect, PhD, the study’s lead author and assistant professor in the school psychology program in the department of disability and psychoeducational studies at the University of Arizona in Tucson. “School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom.”

The five-year study, which appears in the April issue of the journal SLEEP, utilized data from a longitudinal cohort, the Tucson Children’s Assessment of Sleep Apnea Study (TuCASA). The TuCASA study prospectively examined Hispanic and Caucasian children between 6 and 11 years of age to determine the prevalence and incidence of SDB and its effects on neurobehavioral functioning. The study involved 263 children who completed an overnight sleep study and a neurobehavioral battery of assessments that included parent and youth reported rating scales.

Results show that 23 children had incident sleep apnea that developed during the study period, and 21 children had persistent sleep apnea throughout the entire study. Another 41 children who initially had sleep apnea no longer had breathing problems during sleep at the five-year follow-up.

The odds of having behavioral problems were four to five times higher in children with incident sleep apnea and six times higher in children who had persistent sleep apnea. Compared to youth who never had SDB, children with sleep apnea were more likely to have parent-reported problems in the areas of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care. Children with persistent sleep apnea also were seven times more likely to have parent-reported learning problems and three times more likely to have school grades of C or lower.

The authors report that this is the first sleep-related study to use a standardized questionnaire to assess adaptive functioning in typically developing youth with and without SDB.

“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,” said Perfect.

According to the American Academy of Sleep Medicine, obstructive sleep apnea occurs in about two percent of children who are otherwise healthy. Children with sleep apnea generally have larger tonsils and adenoids than other children their age, and most children with sleep apnea have a history of loud snoring. Effective treatment options for children include the surgical removal of the tonsils and adenoids or the use of continuous positive airway pressure (CPAP) therapy.

Citation:

Journal Reference:

  1. Michelle M. Perfect, Kristen Archbold, James L. Goodwin, Deborah Levine-Donnerstein, Stuart F. Quan. Risk of Behavioral and Adaptive Functioning Difficulties in Youth with Previous and Current Sleep Disordered Breathing. SLEEP, 2013; DOI: 10.5665/sleep.2536

American Academy of Sleep Medicine (2013, March 29). Children with sleep apnea have higher risk of behavioral, adaptive and learning problems. ScienceDaily. Retrieved March 29, 2013, from http://www.sciencedaily.com­ /releases/2013/03/130329161243.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily%2Ftop_news+%28ScienceDaily%3A+Top+News%29&utm_content=FaceBook

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Both  studies  should be taken seriously because of the implications for future behavior issues of children. See, Babies’ snoring linked to later behavior problems . http://www.king5.com/health/childrens-healthlink/Babies-snoring-linked-to-later-behavior-problems–143398676.html

Our goal as a society should be:

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

Where information leads to Hope. ©                  Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©                      http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©                                             http://drwildareviews.wordpress.com/

Dr. Wilda ©                                                                                                      https://drwilda.com/

Albert Einstein School of Medicine study: Abnormal breathing during sleep can lead to behavior problems in children

25 Mar

A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination  A physical examination is important to discover any problems which might affect a child’s ability to learn or which might affect the child’s future health.

Albert Einstein School of Medicine announced the study, “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.”

A study of more than 11,000 children followed for over six years has found that young children with sleep-disordered breathing are prone to developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships, according to researchers at Albert Einstein College of Medicine of Yeshiva University. Their study, the largest and most comprehensive of its kind, published online today

“This is the strongest evidence to date that snoring, mouth breathing, and apnea [abnormally long pauses in breathing during sleep] can have serious behavioral and social-emotional consequences for children,” said study leader Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women’s health at Einstein. “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Sleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. Its hallmarks are snoring (which is usually accompanied by mouth breathing) and sleep apnea. SDB reportedly peaks from two to six years of age, but also occurs in younger children. About 1 in 10 children snore regularly and 2 to 4 percent have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids.

“Until now, we really didn’t have strong evidence that SDB actually preceded problematic behavior such as hyperactivity,” said Ronald D. Chervin, M.D., M.S., a co-author of the study and professor of sleep medicine and of neurology at the University of Michigan. “Previous studies suggesting a possible connection between SDB symptoms and subsequent behavioral problems weren’t definitive, since they included only small numbers of patients, short follow-ups of a single SDB symptom, or limited control of variables such as low birth weight that could skew the results. But this study shows clearly that SDB symptoms do precede behavioral problems and strongly suggests that SDB symptoms are causing those problems.”

The new study analyzed the combined effects of snoring, apnea and mouth-breathing patterns on the behavior of children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems….”

— Karen Bonuck, Ph.D.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems,” said Dr. Bonuck.  “The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures.”

Children whose symptoms peaked early—at 6 or 18 months—were 40 percent and 50 percent more likely, respectively, to experience behavioral problems at age 7 compared with normally-breathing children. Children with the most serious behavioral problems were those with SDB symptoms that persisted throughout the evaluation period and became most severe at 30 months.

Researchers believe that SDB could cause behavioral problems by affecting the brain in several ways: decreasing oxygen levels and increasing carbon dioxide levels in the prefrontal cortex; interrupting the restorative processes of sleep; and disrupting the balance of various cellular and chemical. Behavioral problems resulting from these adverse effects on the brain include impairments in executive functioning (i.e., being able to to pay attention, plan ahead, and organize), the ability to suppress behavior, and the ability to self-regulate emotion and arousal.

“Although snoring and apnea are relatively common in children, pediatricians and family physicians do not routinely check for sleep-disordered breathing,” said Dr. Bonuck. “In many cases, the doctor will simply ask parents, ‘How is your child sleeping?’ Instead, physicians need to specifically ask parents whether their children are experiencing one or more of the symptoms—snoring, mouth breathing or apnea—of SDB.”

“As for parents,” said Dr. Bonuck, “if they suspect that their child is showing symptoms of SDB, they should ask their pediatrician or family physician if their child needs to be evaluated by an otolaryngologist (ear, nose and throat physician) or sleep specialist.”

According to the AAO-HNS, surgery is the first-line treatment for severe pediatric SDB in cases where the tonsils and adenoids are enlarged. Another option is weight loss for overweight or obese children.

Dr. Bonuck’s paper is titled “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.” In addition to Dr. Bonuck, other Einstein contributors were Katherine Freeman, Dr.P.H., and Linzhi Xu, Ph.D.

The study was supported by grants from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.                                                 http://www.einstein.yu.edu/news/releases/771/kids-abnormal-breathing-during-sleep-linked-to-increased-risk-for-behavioral-difficulties/

Citation:

Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years

Pediatrics

Karen Bonuck, PhDa, Katherine Freeman, DrPHb, Ronald D. Chervin, MD, MSc, and Linzhi Xu, PhDa

  1. 1.    Published online March 5, 2012(doi: 10.1542/peds.2011-1402)
  2. » AbstractFree
  3. Full Text (PDF)
  4. Supplemental Information

The Cincinnati Children’s Hospital describes the Process of the Physical Examination

Process of the Physical Exam

A thorough history often precedes the physical examination and allows the cardiology staff to determine the reason for referral, significant family and medical history, and symptomatic status with respect to the cardiovascular system.

The history also provides the first interaction of our staff with the patient’s family so that some familiarity can be achieved prior to the performance of the physical examination.

The history is likely to vary somewhat based not only on the age of the patient, but also on the reason for referral.

A detailed history also allows us to tailor the physical examination and, if needed, subsequent testing to deal precisely and thoroughly with the patient’s suspected problem.

The first portion of the physical examination is performed by the screening clinic nurse. Height, weight, blood pressure and oxygen saturation determinations are made in the clinic at the time of being checked into the examination room.

Although these tests are painless, on occasion smaller children are anxious at the performance of blood pressure and pulse oximetry.

Rarely, however, are these tests difficult to obtain. The physical examination performed by the physician can be broken down into three separate parts, all of which are important in the accurate assessment of the patient.

  • Observation: The simple act of observing a patient is often very revealing. Patients are observed for their general sense of distress / discomfort, possible associated abnormalities (for example, orthopedic deformities or Down syndrome) and for any more subtle abnormalities that might be a clue to more serious underlying heart disease, for example, cyanosis or chest asymmetry.
  • Palpation (examination by touching): Using the fingers and hands, the physician in the clinic can gain insight into peripheral circulation (arms and legs) as well as overall heart muscle performance. Signs of peripheral fluid buildup (edema) can also be noted.

The chest is often palpated to determine the location of the heart and its overall degree of activity.

Additionally, some murmurs often create a loud enough noise to be felt through the chest, and the location of these “thrills” can pinpoint a structural heart abnormality.

  • Auscultation (examination by listening): The final portion of the physical examination involves the use of the stethoscope to listen to various sounds that a heart makes.

During the auscultation process, valve closure and opening sounds are determined. We attempt to determine how many valve closure sounds there are, how loud they are, and where they are best heard.

Heart murmurs are characterized by timing in the heart cycle, loudness, pitch, and location. The entire chest and often the back are inspected with the stethoscope during this process.

In addition, extra sounds such as rubs, gallops and clicks are listened for. These, if present, can lead to a precise bedside diagnosis of a cardiac abnormality.

Finally, the lungs and abdomen are examined both by auscultation and palpation so as to determine position and size of abdominal organs, abnormal lung findings and possible murmurs in the abdomen or back.

During the course of the physical examination process, the pulse rate (heart rate) and respiratory rate are determined often by several observers.

The Albert Einstein study should be taken seriously because of the implications for future behavior issues of children. See, Babies’ snoring linked to later behavior problems . http://www.king5.com/health/childrens-healthlink/Babies-snoring-linked-to-later-behavior-problems–143398676.html

Our goal as a society should be:

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

Dr. Wilda says this about that ©