Summary: A study published in JAMA Network Open by the University of Maryland School of Medicine examined nearly 12,000 children in the Adolescent Brain Cognitive Development (ABCD) study to assess the impact of frequent snoring on behavior and cognition. Researchers found that adolescents who snored three or more times per week were more likely to exhibit behavioral problems such as inattention, aggression, and social difficulties. However, these teens did not show any cognitive impairments, such as deficits in memory or reading abilities, compared to their peers. The findings highlight the need for careful evaluation of sleep-disordered breathing in children to differentiate between behavioral and cognitive impacts, potentially preventing misdiagnoses like ADHD.
Key Takeaways:
- Frequent Snoring Linked to Behavior Problems: Adolescents who snored three or more times per week were more likely to exhibit inattention, rule-breaking, and aggression, though their cognitive abilities remained unaffected.
- Snoring Declines with Age: The study found that snoring rates naturally decreased as children grew older, even without treatment, suggesting resilience in adolescent brain development.
- Importance of Evaluating Sleep Disorders: Researchers recommend consulting a pediatrician for a sleep study to address behavioral issues in children before considering ADHD evaluations or stimulant medications.
Adolescents who snore frequently were more likely to exhibit behavior problems such as inattention, rule-breaking, and aggression, but they do not have any decline in their cognitive abilities, according to a new study conducted by researchers at the University of Maryland School of Medicine.
Researchers say this is the largest study to date tracking snoring in children from elementary school through their mid-teen years and that it provides an important update to parents dealing with what medical measures to take to help manage snoring in their children.
The findings were published in JAMA Network Open.
Study Design and Key Findings
To conduct the study, researchers analyzed the parent-reported snoring data, cognitive, and behavioral test outcomes of nearly 12,000 children enrolled in the national Adolescent Brain Cognitive Development (ABCD) study, the largest study of brain development and child health in the .S. Children were enrolled in the study at ages 9-10 and had annual visits through age 15 to assess their snoring frequency, cognitive abilities, and behavioral issues.
The researchers found that adolescents who snore three times or more per week were more likely to have behavioral problems such as inattentiveness in class, social difficulties with friendships, or adequately expressing their thoughts and emotions. However, these teens who snored did not exhibit any differences in their reading and language abilities, nor any difference on memory or cognitive processing tests compared to their peers who did not snore. The researchers also found that snoring rates declined as children grew older even without any treatment.
“Adolescence is a period when the brain’s resilience withstands adverse inputs, which could explain why we are seeing the preservation of cognition in light of habitual snoring,” says Amal Isaiah, MD, PhD, MBA, study co-author, chief of pediatric otorhinolaryngology at the University of Maryland School of Medicine and faculty at the Institute for Health Computing, in a release. “If a child is experiencing behavioral issues, it may be time to consult a pediatrician about a sleep study perhaps even before an evaluation for attention deficit hyperactivity disorder (ADHD). We hope that these findings will further distinguish the behavioral versus cognitive effects of snoring to improve our approaches to treatment.”
Implications for Diagnosis and Treatment
As many as 15% of American children have some form of sleep-disordered breathing, and a significant percentage of these children are misdiagnosed as having ADHD and treated unnecessarily with stimulant medications, according to researchers. Isaiah’s findings expand upon his previous research linking frequent snoring to concerning brain changes and behavioral problems in children, with long-term follow-up of these children into their teen years.
Frequent snoring in children is often associated with poor health outcomes including poor classroom performance, problem behaviors, and lower quality of life. While clinical associations advocate for proactive treatment of sleep-disordered breathing, the lack of available data from the population presents challenges in weighing the appropriate management options such as surgery to remove the adenoids and tonsils (adenotonsillectomy) and other non-surgical options.
Advancing Research with AI and Larger Datasets
“Dr Isaiah utilized sophisticated data analytics to examine over one million data points, assessing the impact of sleep-disordered breathing on the developing brains of children through adolescence,” says Mark T. Gladwin, MD, who is the John Z. and Akiko K. Bowers Distinguished Professor and Dean of the University of Maryland School of Medicine, and vice president for medical affairs at University of Maryland, Baltimore, in a release. “With novel computational and AI tools now available at the UM Institute for Health Computing, calculations that once took months can now be completed in a matter of days.”
The research team plans to further utilize AI capabilities at UM Institute for Health Computing to process larger datasets and examine the causal relationship between snoring and brain outcomes.
The study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health and the various funders of the ABCD study.
The University of Maryland School of Medicine is one of 21 research sites involved in the ABCD study and faculty, including Isaiah, are co-investigators on this ongoing research. Study co-authors Linda Chang, MD, MS, and Thomas Ernst, PhD, are site principal investigators.
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