When children are struggling to do well in school, pediatricians will often ask if the child is getting enough sleep, which sometimes results in the discovery of sleep apnea. Now a new study shows that it’s just as important to pay attention to the sleeping habits of high-achieving children.
The findings, published in the International Journal of Pediatric Otorhinolaryngology, suggest that all children, from low IQ to high IQ groups, improve at a similar level after treatment for obstructive sleep apnea.
Obstructive sleep apnea is a condition in which children stop breathing for a few seconds to several seconds many times in the night due to enlarged tonsils and adenoids.
Prior research shows that an adenotonsillectomy can lead to behavioral improvements in children who are struggling in the classroom or at home. But this study was the first to focus on children who were already doing well in school.
In fact, higher-IQ children may be less likely to have obstructive sleep apnea recognized and treated if they do not show problems with school performance.
For the study, researchers evaluated 147 children ages three to 12 that were scheduled for an adenotonsillectomy, a procedure that removes both the tonsils and the adenoids. These children also were suspected of having obstructive sleep apnea, a common reason for adenotonsillectomy.
“When a clinician sees a pediatric patient who has a problem in school, they ask about sleep,” said study co-author Ronald Chervin, M.D., neurologist and director of the University of Michigan Sleep Disorders Center. “We wondered, in high-performing children, do we still need to worry about snoring or sleep issues?”
The findings show that all of the children, from the lowest IQ to the highest, improved at a similar level when their sleep and behavior were evaluated six months after the adenotonsillectomy procedure.
Parents rated their child’s behavior in areas such as inattention, hyperactivity, social problems, and perfectionism. Sleep tests included monitoring brain wave patterns, eye movements, heart rhythm, muscle activity, airflow at the nose and mouth, chest movements, and snoring.
“Regardless of intellectual level, we can expect to see some behavioral improvement along with better sleep,” said study co-author Bruno Giordani, Ph.D., professor of neurology, psychiatry, psychology, and nursing. “Once behavior improves, attention in school improves, and emotional ability and behavioral and impulsivity control improve.”
In obstructive sleep apnea, the air stops in the throat, causing the child to choke, wake up briefly to open the airway and then go back to sleep. This can happen more than a hundred times in a night.
It can be difficult to detect, because rather than acting tired, a sleep-deprived child may become hyperactive, leading parents and caregivers to wonder about other reasons for the behavior.
“Children with obstructive sleep apnea are fidgeting and not able to stay on task, because they’re doing anything they can to stay awake,” said first author Seockhoon Chung, M.D., Ph.D., who began the research as a University of Michigan research fellow but is now associate professor at Asan Medical Center in South Korea. “Even when those behavioral problems are minimal, improvement is still possible.”
“Deciding whether to perform an adenotonsillectomy should be about the physician’s view of how bad the sleep problem is, and how significantly it appears to be related to the tonsil and adenoid issue,” Giordani says. “Then, the physician can think about how that fits together with the child’s appearance and behavior, expecting neurobehavioral benefit.”
The new findings suggest that other signs and symptoms of sleep apnea, such as loud nightly snoring, should not be ignored, because the brain and daytime behavior of a child with higher IQ may still benefit from diagnosis and treatment of the sleep disorder.