Sleep Apnea in Children, Part 2: Attention and Memory

We all think our own children are the brightest and only want the best for them in their intellectual and academic success. But who would have thought that something as simple as their cute little snore at night could be the reason they struggle behind in school and misbehave at times?

It turns out that children suffering from a wide range of sleep conditions, from light snoring to Obstructive Sleep Apnea, can have greater difficulty recalling memories than those without any symptoms.

More Than Just a Snore

Memory occurs over three stages: learning, consolidating and recalling. But constant pauses in breathing throughout the night has shown to interfere with the last stage of memory development, making the sleeper find difficulties in recollection.

And obviously, this difficulty can damage any adult’s ability to build on previous knowledge, let alone a child’s ability. Not only that, but untreated sleep apnea in children can also lead to a lack of certain brain developments vital to their overall mental capabilities throughout their lives.

In August of 2006, the Johns Hopkins University did a study that compared 19 children with Obstructive Sleep Apnea to 12 children who showed no signs of sleep disorders. “Using a special type of MRI, researchers identified changes to the hippocampus and the right frontal cortex.

Next, using IQ tests and other standardized performance tests that measure verbal performance, memory and executive function, researchers were able to link the changes in the two brain structures to deficits in neuropsychological performance.”

“Using magnetic resonance spectroscopic imaging, which plots peak levels of brain chemicals in the form of graphs, researchers compared the ratios between each two of three chemicals – N-acetyl aspartate (NAA), creatine and choline – in children with apnea and in those without. The hippocampus and the right frontal cortex of children with sleep apnea showed altered ratios of these neurochemicals that are not specific to any one disease but indicate injury to brain cells.”

For reference, the hippocampus is a structure to the temporal lobe and is vital to storing our learning and memories. It also develops significantly during childhood and through the teenage years, only fully maturing in our 30s. Meanwhile, the right frontal cortex oversees elevated thinking that involve recalling old memories and applying them to new situations.

The damage linked between these two brain functions means lower IQ scores and tested measures such as verbal working memory and word fluency, creating disadvantages that last long into adulthood.

This study is not an isolated example of sleep apnea impairing children’s learning abilities, either. A more recent study showed similar results in kids without sleep disorders tested compared to those with OSA and even those with any form of Sleep Disordered Breathing, a range of sleeping disorders that range from light snoring to OSA.

During the study, examiners discovered that “the level of deficit correlated with reduced numbers of N2 sleep spindles. They also noted that N2 sleep spindles were reduced more in those who snored the most.”

By the end of their conclusions, the authors determined that “processes are disrupted at even low severity levels of SDB and suggests that treatment of mild OSA could be beneficial for memory processes in children.”

The Missing Link?

The connection between sleep apnea and loss of memory makes plenty of sense when you consider the signs of OSA in children. Other than snoring and daytime sleepiness, signs that your child may have sleep apnea is whether or not they have a poor attention span and low performance in school.

In fact, some practitioners wonder how many of the 11% of children with Attention Deficit Hyperactivity Disorder have been misdiagnosed and instead have a sleep disorder that’s being mistreated with medication like Ritalin as opposed to an observation and consultation with a sleep expert.

Citing a study completed by the American Academy of Pediatrics that includ over 11,000 children, HuffingtonPost explained the conclusions found that “those with sleep-disordered breathing were significantly more likely to show signs of hyperactivity, trouble interacting with peers, and conduct issues including aggressiveness and inability to follow rules.

The study examined the effects of sleep-disordered breathing on children as young as 6 months. Researchers found that very young children who experienced some form of sleep-disordered breathing were, by the age of 7, 40-100 percent more likely to have behavioral problems similar to those used to diagnose ADHD.”     

While recognition and treatment of ADHD is critical, this revelation could be beneficial in the treatment of behavior and mental well-being. And early treatment is most beneficial to the child before stronger side effects develop that interfere with their learning abilities.

What You Can Do

With so many causes and so many treatments for your child’s sleep dilemmas, it can be overwhelming to figure out the next steps. Here are the most common and effective treatments for your young one’s Sleep Disorder Breathing.

• Dental work: The site com cites that one form of OSA treatment in kids is a “comprehensive oral examination.” Other advanced treatment could even include a palate expander, which is a “removable orthodontic appliance… As soon as the palate is expanded, it opens the airway.” At your child’s next dental appointment, ask their dentist whether they may benefit from a more comprehensive evaluation and oral treatment.
• Adenoids removed: Adenoids are a lump of tissue behind the nostrils and could be the culprit to some pediatric OSA. If your child’s adenoids are larger than normal, then surgical removal may be the answer to open their airway more and improve breathing at night. This procedure would be done by an otolaryngologist, or a doctor who specializes in problems related to the ears, nose and throat. The next time you see your family practitioner, ask about the possibilities of enlarged adenoids in your little one.