Finding Could Explain Why Snoring and Disrupted Sleep Are Associated with Behavioral Problems Including Inattention, Hyperactivity, and Aggression
Children who regularly snore have structural changes in their brain that may account for the behavioral problems associated with the condition, including lack of focus, hyperactivity, and learning difficulties at school. That is the finding of a new study conducted by researchers at the University of Maryland School of Medicine (UMSOM), which was published today in the journal Nature Communications.
The research was supported by the National Institute on Drug Abuse (NIDA) and nine other Institutes, Centers, and Offices of the National Institutes of Health.
To conduct the study, the researchers examined MRI images that were collected from more than 10,000 children aged 9 to 10 years who were enrolled in the Adolescent Brain Cognitive Development (ABCD) study. This is the largest long-term study of brain development and child health in the US, and UMSOM researchers are co-investigators in this ongoing research.
The researchers found that children who snored regularly (three or more times per week), as reported by their parents, were more likely to have thinner gray matter in several regions in the frontal lobes of their brain. These areas of the brain are responsible for higher reasoning skills and impulse control. The thinner cortex in these regions correlated with behavioral disturbances associated with sleep disordered breathing, a severe form of which is called sleep apnea. These behavioral problems include a lack of focus, learning disabilities, and impulsive behaviors. The snoring condition causes disrupted sleep throughout the night due to interrupted breathing and reduction in oxygen supply to the brain.
“This is the largest study of its kind detailing the association between snoring and brain abnormalities,” said study lead author Amal Isaiah, MD, PhD, Associate Professor of Otorhinolaryngology--Head and Neck Surgery and Pediatrics at UMSOM. “These brain changes are similar to what you would see in children with attention deficit hyperactivity disorder. Children have a loss of cognitive control, which is additionally associated with disruptive behavior.”
Up to 10 percent of American children have obstructive sleep disordered breathing, and a significant percentage are misdiagnosed as having ADHD and treated with stimulant medications.
Dr. Isaiah offered this advice to parents: “If you have a child who is snoring more than twice a week, that child needs to be evaluated. We now have strong structural evidence from brain imaging to reinforce the importance of diagnosing and treating sleep disordered breathing in children.”
The condition can be treated with tonsillectomy and adenoidectomy, considered the first line of treatment of children with symptoms of snoring, breathing pauses during sleep, and mouth breathing.
“We know the brain has the ability to repair itself, especially in children, so timely recognition and treatment of obstructive sleep disordered breathing may attenuate these brain changes. More research is needed to validate such mechanisms for these relationships which may also lead to further treatment approaches,” said study co-author Linda Chang, MD, MS, Professor of Diagnostic Radiology and Nuclear Medicine who is a co-principal investigator on the ABCD study.
The researchers plan to conduct a follow-up study to determine whether children who continued to snore experienced worsening brain findings on their MRI.
"For the first time, we see evidence on brain imaging that measures the toll this common condition can take on a child’s neurological development,” said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, the John Z. and Akiko K. Bowers Distinguished Professor, and Dean of the University of Maryland School of Medicine. “This is an important finding that highlights the need to properly diagnose snoring abnormalities in children.”
About the University of Maryland School of Medicine
Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 45 academic departments, centers, institutes, and programs; and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically based care for nearly 2 million patients each year. The School of Medicine has more than $563 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 student trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of nearly $6 billion and an economic impact more than $15 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity, is an innovator in translational medicine, with 600 active patents and 24 start-up companies. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu