Preemies and blacks most susceptible - Sleep Disorders

A serious sleep-related breathing disorder could make it difficult for children to think or perform well in school and may lead to severe growth or heart problems, according to researchers at Case Western Reserve University School of Medicine, Cleveland, Ohio, and Rainbow Babies & Children's Hospital. The study also revealed two groups of children at much greater risk for Sleep Disordered Breathing (SDB)--African-Americans and youngsters who were born prematurely.

African-American youths are up to six times as likely as white children to exhibit signs of SDB. Those born prematurely (less than 36 weeks gestation) were found to have up to a five times greater risk than full-term offspring.

In SDB, there is a prolonged complete or partial airway collapse that disrupts breathing during sleep. It is a common medical occurrence in adults and is increasingly diagnosed in youth. If unrecognized and untreated, SDB can lead to serious complications for children, including behavior and learning difficulties, growth impairment, and even heart ailments. In adults, it can result in or worsen life-threatening conditions, including an increased risk of hypertension and cardiovascular disease.

"In previous studies, the prevalence of SDB was based on parental reports of children's snoring, which may be unreliable," explains Carol Rosen, associate professor of pediatrics, pulmonology, and neurology at CWRU and medical director of Pediatric Sleep Services at Rainbow Babies & Children's Hospital. "In this study, we actually measured SDB with special equipment in participants' homes, allowing us to gel a truer estimate of SDB in kids. We found it affected about 2.2% of otherwise healthy eight- to 11-year-old children.

"More research is needed to understand the risk mechanisms. Is it related to bone structure or soft tissues? Or is it somehow tied to an increased risk for other conditions, such as diabetes, hypertension, or obesity?"

Researchers believe the prematurity risk may be based on negative exposures in the womb or other exposures after birth that influence the development of respiratory control or upper airway size. "In the womb, face or upper airway shape may not be fully formed, or other lung or neurological problems could evolve because of the shortened development period," Rosa theorizes. "After birth, intensive care procedures, such as exposure to ventilators and extra oxygen, may alter a baby's breathing responses."

Based on their findings, the researchers say more intensive screening for SDB by primary care providers may be beneficial. "We've now identified two high risk groups for Sleep Disordered Breathing," Rosen attests. "Our research, along with the Academy of Pediatrics' recent recommendation to screen [youngsters] for snoring and obstructive sleep apnea, should help identify more vulnerable children."

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