Sleep Disorders and Behavioral Problems in Children

Common sleep disorders faced by children are sleep apnea, snoring and nightmares. Researchers say that doctors and parents should take these sleep disturbances seriously as they can lead to medical and behavioral problems later on .

According to the Delta Sleep Lab, over 2 million children suffer from sleep disorders and nearly 30-40 percent of the children do not sleep enough.

A scientist at the Albert Einstein College of Medicine of Yeshiva University says that children with sleep-related problems frequently have concurrent behavioral problems and vice a versa.

This new study emphasizes on the fact that pediatricians, respiratory specialists and sleep medicine specialists should work together whenever a sleep problem is suspected.

"Our findings should raise awareness among parents and physicians that if a child is sleeping poorly, they should delve deeper to see if there is an unrecognized respiratory-related sleep problem," said senior author Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women's health at Einstein. "The best way to make sure this happens is by taking an interdisciplinary approach to the care of these children."

According to Dr. Bonuck, not much is known about the co- occurrence of behavioral sleep problem and sleep disordered breathing (SDB).

Dr. Bonuck along with her colleagues conducted a study to gain a complete insight into the prevalence and duration of behavioral sleep problems and of SDB in a large population. The subjects included children aged 18 months to 5-year-olds.

They also analyzed the data of the 11,000 children who were enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

The parents were asked to mail the questionnaires. They were asked to report on a child's snoring, apnea at 18, 30, 42 and 57 months of age. Apart from this they were also asked whether during the same interval their child refused to go to bed, woke up early, had difficulty sleeping, had nightmares, got up after being put to bed, woke in the night, or awakened after a few hours.

Those children who reported five or more of these behaviors were considered to suffer from clinically significant behavioral sleep problem.

The prevalence of behavioral sleep problems over the 18 to 57-month age reporting period ranged from 15 to 27 percent with a peak at 30 months of age. Among children with behavioral sleep problems, 26 to 40 percent had habitual SDB, again peaking at 30 months. Among children who had habitual SDB, 25 to 37 percent also had a behavioral sleep problem, peaking at 30 months.

Dr. Bonuck notes that behavioral sleep problems cause SDB, the opposite may also be true. Frequent night wakings initially related to SDB may be in response to parents' anxiety. These behaviors may, in turn, develop into persistent behavioral sleep problems, despite adequate treatment for SDB.

"It's important that we pay attention to how our children are sleeping," said Dr. Bonuck. "There's ample evidence that anything that interrupts sleep can negatively affect a child's emotional, cognitive, behavioral and academic development. Fortunately, snoring and apnea are highly treatable, and there are many effective interventions for behavioral sleep problems."

The paper is titled "Co-morbid symptoms of sleep disordered breathing and behavioral sleep problems from 18 -- 57 months of age: A population-based study." The lead author is Melisa Moore, Ph.D. (Children's Hospital of Philadelphia, PA.)

The study was published Dec. 4 in the online edition of Behavioral Sleep Medicine.