Sleep-disordered breathing negatively impacts child development: yes, no, maybe?

A CHILD'S POOR SLEEP IS A COMMON CONCERN FOR PARENTS. IN OTHER WORDS, THE LITERATURE REPORTS PREVALENCE RATES OF SLEEP DISORDERS IN CHILDREN RANGING FROM 20 TO 60% OR MORE, ESPECIALLY IN CHILDREN WITH ATYPICAL DEVELOPMENT (E.G., DOWN SYNDROME).1-3

Let's now talk about a significant sleep problem: sleep-disordered breathing. Breathing is a complex physiological process that begins in utero with the respiratory movements of the fetus.

The control of ventilation (respiratory centers of the brainstem) depends on the input from chemoreceptors, motor input (for example, the movement of our chest) and behavioral input (for example, holding your breath when you dive).

We will focus on the symptoms of primary snoring, mouth breathing, breathing interruption (hypopnea) and cessation of breathing (apnea) during sleep.4

Based on polysomnography studies, the severity of sleep-disordered breathing is measured.5 Obstructive sleep apnea, for example, is very common, affecting 2 to 3% of all children.6-8 Note that, the most important function of breathing is the supply of oxygen to the body and the balancing of carbon dioxide levels.

Consequently, we can distinguish some breathing difficulties: obstructive apnea, central apnea, mixed apnea, periodic breathing.

Clinically, the most commonly used indicator of airway obstruction is the apnea-hypopnea index (AHI).

It was created by Dr. Christian Guilleminault, a French doctor. But there are different indexes, e.g., hypercapnia or arousal.

In summary, it is the degree of airway obstruction that will define the spectrum of sleep-disordered breathing.4,6,11,12

Moreover, sleep-disordered breathing has multiple additional comorbidities such as obesity or metabolic syndrome.4,9,10 Recent studies progressively reveal furthermore the multidirectional relationships between sleep-disordered breathing and a child's development.

The assessment of the impact of sleep-disordered breathing on child development,13-22 shows that the most frequently reported is metabolic syndrome.

In children, we see: stunted growth, childhood obesity, inflammatory disorders, cardiovascular consequences.

Regarding the impact of sleep-disordered breathing in the areas,23-28 of intelligence, schooling, attention, executive function, memory, language, and visuospatial ability, it was mainly studies including primary snoring or different AHI indices.

Incorporating the spectrum, the studies suggest general intellectual problems and memory issues, especially for school-age children, while younger children may present attention issues.

Thus, they exhibit average to poor performances. Translated to their main development task - academic achievement, we have shown through a meta-analysis that they underperform at all academic levels.

Studies show that behavioral problems are common and can be of internalized or Prof. Dr. Karen Spruyt University of Paris, NeuroDiderot INSERM externalized type.

It is also important to note that in children with intellectual/developmental disabilities, their behavior and performances could be doubly affected by this sleep problem.

These children are often described as resembling ADHD. These are the children in class that you can describe as the child with a "slow cognitive rhythm".

In conclusion, studies support that sleep-disordered breathing presents an increased risk for the health of the young, and the less young.

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