Significant Brain Changes Found in Children Who Regularly Snore – May Explain Hyperactivity and Aggression

Finding could explain why snoring and disrupted sleep are associated with behavioral problems including inattention, hyperactivity, and aggression.

Children who regularly snore have structural changes in their brain that may account for the behavioral problems associated with the condition including lack of focus, hyperactivity, and learning difficulties at school. That is the finding of a new study conducted by researchers at the University of Maryland School of Medicine (UMSOM), which was published today (April 13, 2021) in the journal Nature Communications.

The research was supported by the National Institute on Drug Abuse (NIDA) and nine other Institutes, Centers, and Offices of the National Institutes of Health.

To conduct study, the researchers examined MRI images collected from more than 10,000 children aged 9 to 10 years enrolled in the Adolescent Brain Cognitive Development (ABCD) study, the largest long-term study of brain development and child health in the US. UMSOM researchers are co-investigators in this ongoing study.

Thinner Gray Matter Impacts Focus and Behavior

They found that children who snored regularly (three or more times per week), as reported by their parents were more likely to have thinner gray matter in several regions in the frontal lobes of their brain. These areas of the brain are responsible for higher reasoning skills and impulse control. The thinner cortex in these regions correlated with behavioral disturbances associated with sleep disordered breathing, a severe form of which is called sleep apnea. These behavioral problems include a lack of focus, learning disabilities, and impulsive behaviors. The snoring condition causes disrupted sleep throughout the night due to interrupted breathing and reduction in oxygen supply to the brain.

“This is the largest study of its kind detailing the association between snoring and brain abnormalities,” said study lead author Amal Isaiah, MD, PhD, Associate Professor of Otorhinolaryngology — Head and Neck Surgery and Pediatrics at UMSOM. “These brain changes are similar to what you would see in children with attention deficit hyperactivity disorder. Children have loss of cognitive control which is additionally associated with disruptive behavior.”

Up to 10 percent of American children have obstructive sleep disordered breathing, and a significant percentage are misdiagnosed as having ADHD and treated with stimulant medications.

Dr. Isaiah offered this advice to parents: “If you have a child who is snoring more than twice a week, that child needs to be evaluated. We now have strong structural evidence from brain imaging to reinforce the importance of diagnosing and treating sleep disordered breathing in children.”

Surgical Options Can Reverse Brain Changes

The condition can be treated with tonsillectomy and adenoidectomy, considered the first line of treatment of children with symptoms of snoring, breathing pauses during sleep, and mouth breathing.

“We know the brain has the ability to repair itself, especially in children, so timely recognition and treatment of obstructive sleep disordered breathing may attenuate these brain changes. More research is needed to validate such mechanisms for these relationships which may also lead to further treatment approaches,” said study co-author Linda Chang, MD, MS, Professor of Diagnostic Radiology and Nuclear Medicine who is a co-principal investigator on the ABCD study.

The researchers plan to conduct a follow-up study to determine whether children who continued to snore experienced worsening brain findings on their MRI.

“For the first time, we see evidence on brain imaging that measures the toll this common condition can take on a child’s neurological development,” said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. “This is an important finding that highlights the need to properly diagnose snoring abnormalities in children.”

Reference: “Associations between frontal lobe structure, parent-reported obstructive sleep disordered breathing and childhood behavior in the ABCD dataset” by Amal Isaiah, Thomas Ernst, Christine C. Cloak, Duncan B. Clark and Linda Chang, 13 April 2021, Nature Communications.
DOI: 10.1038/s41467-021-22534-0

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