Loudness of Snoring May Indicate Greater Hyperactivity in Children and Adolescents
Loudness of snoring, regardless of hypoxic burden and obstructive sleep apnea syndrome severity (OSAS), may contribute to hyperactivity in pediatric patients, according to an observational prospective study published in Sleep Medicine.
“The main results of our observational prospective study were that the prevalence of hyperactivity behavior in snoring children and adolescents referred for OSAS suspicion were high (25–36 % according to the type of symptoms) and that loudness of snoring, probably associated to an upper airway resistance syndrome, but not the apnea-hypopnea index was linked to hyperactivity symptoms,” the authors said. “It emphasizes that OSAS is not responsible per se of ADHD symptoms.”
The study analysis included 512 children aged 3-18 years old who were habitual snorers and/or referred for suspicion of OSAS. The patients completed overnight polysomnography to measure apnea-hypopnea index (AHI) and hypoxic burden. They were also assessed for acoustic rhinometry and completed clinical examination, while parents answered questions regarding snoring volume alongside the Conners’ Parent Rating Scale-Hyperactivity Index (CPRS-HI).
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Of the sample, 358 (70%) children were overweight or obese and 179 (35%) had an obstructive AHI >3/h. Analysis results showed that 36 % [95 % CI: 32%–41 %] of children exhibited increased hyperactivity/impulsivity, and 25 % [21%–29 %] showed emotional lability. Snoring loudness was significantly correlated with higher hyperactivity scores, particularly for hyperactivity/impulsivity, while hypoxic burden showed no significant association (rhos = −0.09; p = 0.082). Multivariate analysis showed that the presence of very loud as compared to mildly quiet snoring was an independent predictor of hyperactivity symptoms, while an obstructive AHI >3/h was associated with decreased hyperactivity scores.
The unique study may have been limited by its reliance on parental reporting of snoring levels and behavioral functioning. Additionally, hypoxic burden has not been previously assessed, so the authors had no previously published research to compare findings to.
“Our findings suggest that although OSAS can induce statistically significant yet mild behavioral effects, it does not seem to mimic ADHD symptoms as assessed by the Conners’ Parent Rating Scale – Hyperactivity Index,” the authors concluded. “Therefore, when facing a child with parental complaints of hyperactivity and who does not meet the diagnostic criteria of ADHD after undergoing a thorough evaluation as recommended by the American Academy of Pediatrics, and in the presence of very loud snoring, a treatment targeting this symptom should be considered.
However, our study does not answer the question of whether addressing the underlying causes of very loud snoring will increase the anticipation of improved behavioral control.”
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