Snoring affects 10% of the pediatric population and can be associated with obstructive sleep apnoea. Recent work has demonstrated two significant findings in children that snore – adverse brain performance and behaviour.
Firstly, children who snore appear to have increased risk of poor neurocognitive development and performance. Recent work by Hogan et al demonstrated reduced cerebral blood flow velocity and cognition in children who snore, which significantly improved following adenotonsillectomy [1]. This impact on brain development seems to be greatest in preschool and early school aged children, but can affect children well into adolescence. Episodic hypoxia and sleep fragmentation that occurs with snoring and sleep disordered breathing children has a profound effect on the developing central nervous system [2]. In large metanalyses these poor cognitive outcomes seem to reverse with adenotonsillectomy in up to 90% of children.
Secondly, snoring children have demonstrable poor behaviour that is often correctable by adenotonsillectomy [3-5]. Improvements in behaviour following adenotonsillectomy are marked in the first 6 months but still present in long term follow up studies [6]. Children following adenotonsillectomy showed improvement in the behavioural assessment system for children as well as reduced inattention, depression and hyperactivity subscales following the surgery [5]. Studies of children with attention deficit hyperactivity disorder (ADHD) and snoring show that adenotonsillectomy reduces the use of methylphenidate (MPH) and may completely obviate the use of the drug, potentially “curing” the child of ADHD [7].
Certainly not all children who snore have large adenoids and tonsils that are obstructing the airway. A small percentage of snoring children have other areas of airway obstruction such as a deviated nasal septum, large nasal turbinate, micrognathia (small mandible) and a large tongue. Furthermore, a subset of children may suffer from hypotonia of the oropharyngeal musculature along with poor coordination that may contribute to snoring and sleep disordered breathing. Current best practice recommends, that all children who snore continuously for more than 3 months, should be assessed by an ENT surgeon to correct this potentially significant problem.
The Norwest ENT Group surgeons, Nirmal Patel and Tobias Pincock have a particular interest in children’s ENT disorders in particular children’s snoring, ear infections and hearing loss. The Norwest ENT group surgeons use the latest technique of coblation adenotonsillectomy, which removes the tonsils at 40 to 70 degrees, as compared to 400 degrees for convention diathermy removal. The reduced heat dispersion of Coblation adenotonsillectomy is said to translate into less pain for the child with quicker return to eating and quicker healing times. For more information on snoring in children please visit: http://www.norwestent.com/Tonsils_Adenoids.htm#sleep_disorder
References:
1. Hogan, A.M., et al., Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy. Pediatrics, 2008. 122(1): p. 75-82.
2. Gozal, D., Obstructive sleep apnea in children: implications for the developing central nervous system. Semin Pediatr Neurol, 2008. 15(2): p. 100-6.
3. Owens, J.A., Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatr Pulmonol, 2009. 44(5): p. 417-22.
4. Ericsson, E., I. Lundeborg, and E. Hultcrantz, Child behavior and quality of life before and after tonsillotomy versus tonsillectomy. Int J Pediatr Otorhinolaryngol, 2009. 73(9): p. 1254-62.
5. Mitchell, R.B. and J. Kelly, Behavioral changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy. Laryngoscope, 2007. 117(9): p. 1685-8.
6. Wei, J.L., et al., Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing: long-term follow-up. Arch Otolaryngol Head Neck Surg, 2009. 135(7): p. 642-6.
7. Huang, Y.S., et al., Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Med, 2007. 8(1): p. 18-30.