Sleep problems, common in childhood and adolescence, have a significant association with daytime cognitive impairment, behavioural problems, poor school performance and inattention.

Sleep disturbance or disorders in children may be the result of underlying medical conditions or psychological problems. Early diagnosis and treatment leads to the improvement of neuro-cognitive function and behavioural problems.

Dr Veena Judge, Paediatric Respiratory & Sleep Physician

Dr Veena Judge, Paediatric Respiratory & Sleep Physician

Obstructive sleep apnoea (OSA) is by far the commonest diagnosed paediatric sleep disorder, affecting 2-5% of all children, with peaks in the preschool years. The commonest cause being adenotonsillar hypertrophy.

The risk of OSA increases with obesity affecting up to 50% of overweight or obese children. Children with hypotonia, muscle weakness, craniofacial abnormalities (micro/retrognathia) and syndromes such as Trisomy 21, Pierre-Robin, achondroplasia are at increased risk. Allergic rhinitis and asthma are also risk factors.

OSA is characterised by episodes of upper airway obstruction (partial or complete) and blood-gas changes during sleep. The most common presentation is snoring and difficulty or pauses in breathing during sleep. These events (apnoeas) are terminated by arousal which is a protective mechanism that results in fragmented or disturbed sleep.

Behavioural consequences

Sleep fragmentation and hypoxemia results in neuro-cognitive and behavioural consequences. In children, this manifests as daytime hyperactivity, behavioural issues, poor school performance.

Learning and school performance

Studies of primary schoolchildren demonstrated a higher proportion of OSA in those in the lowest 10% of academic performance, with subsequent improvement following treatment. The reciprocal has also been shown, that is children with poor academic performance are more likely to have sleep disturbances.

As a child’s optimal academic performance is unknown, it is possible that there may still be residual deficits. Teenagers who snored frequently in early childhood (compared to non-snorers) have been shown to be at increased risk for lower academic performance later in life well after snoring had resolved.

ADHD and sleep

Children with OSA can have oppositional behaviour, cognitive problems, in attention and hyperactivity. Some of these children fulfil criteria for diagnosis of ADHD. Studies have reported that children with mild OSA demonstrate diminished selective and sustained attention compared with controls.

These deficits substantially improved following treatment (adenotonsillectomy). Hence careful evaluation of these children is vital to ensure correct diagnosis and treatment.

Sleep disorders in children are common and can cause significant daytime disruption with behavioural and cognitive impairment. Early detection and treatment may prevent or improve behavioural and cognitive impairment.

key messages

  • Snoring is common but should not be regarded as normal
  • Paediatric sleep disorders are common and can cause neurocognitive deficit, poor school performance and behavioural problems. Early treatment may prevent or improve impairment
  • Children with suspected ADHD may have OSA

References available on request.

Questions? Contact the editor.

Author competing interests: None to disclose.

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