Summary: Adolescents who snore frequently are more likely to show behavioral issues such as inattention, rule-breaking, and aggression, but their cognitive abilities, including memory and language skills, remain unaffected, a new study reveals. Researchers analyzed data from nearly 12,000 children in the Adolescent Brain Cognitive Development study, the largest U.S. brain development project. They found snoring rates naturally declined as children aged, even without treatment, but persistent snorers showed behavioral difficulties that might be mistaken for ADHD.
Key Facts:
- Teens who snore frequently show behavioral issues but retain normal cognitive skills.
- Snoring rates decline with age, even without medical intervention.
- Many children with sleep-disordered breathing are misdiagnosed with ADHD and treated unnecessarily with stimulants.
Source: University of Maryland
Adolescents who snore frequently were more likely to exhibit behavior problems such as inattention, rule-breaking, and aggression, but they do not have any decline in their cognitive abilities, according to a new study conducted by researchers at the University of Maryland School of Medicine (UMSOM).
This is the largest study to date tracking snoring in children from elementary school through their mid-teen years and it provides an important update to parents struggling with what medical measures to take to help manage snoring in their children.
The findings were recently published in JAMA Network Open.
To conduct the study, researchers analyzed the parent-reported snoring data, cognitive, and behavioral test outcomes of nearly 12,000 children enrolled in the national Adolescent Brain Cognitive Development (ABCD) study, the largest study of brain development and child health in the U.S. Children were enrolled in the study at ages 9-10 and had annual visits through age 15 to assess their snoring frequency, cognitive abilities, and behavioral issues.
The researchers found that adolescents who snore three times or more per week were more likely to have behavioral problems such as inattentiveness in class, social difficulties with friendships or adequately expressing their thoughts and emotions.
However, these teens who snored did not exhibit any differences in their reading and language abilities, nor any difference on memory or cognitive processing tests compared to their peers who did not snore.
The researchers also found that snoring rates declined as children grew older even without any treatment.
“Adolescence is a period when the brain’s resilience withstands adverse inputs, which could explain why we are seeing the preservation of cognition in light of habitual snoring,” said Amal Isaiah, MD, PhD, MBA, study co-author, Chief of Pediatric Otorhinolaryngology at UMSOM and faculty at the Institute for Health Computing.
“If a child is experiencing behavioral issues, it may be time to consult a pediatrician about a sleep study perhaps even before an evaluation for attention deficit hyperactivity disorder (ADHD). We hope that these findings will further distinguish the behavioral versus cognitive effects of snoring to improve our approaches to treatment.”
As many as 15 percent of American children have some form of sleep disordered breathing and a significant percentage of these children are misdiagnosed as having ADHD and treated unnecessarily with stimulant medications.
Dr. Isaiah’s findings expand upon his previous research linking frequent snoring to concerning brain changes and behavioral problems in children, with long-term follow-up of these children into their teen years.
Frequent snoring in children is often associated with poor health outcomes including poor classroom performance, problem behaviors, and lower quality of life.
While clinical associations advocate for proactive treatment of sleep disordered breathing, the lack of available data from the population presents challenges in weighing the appropriate management options such as surgery to remove the adenoids and tonsils (adenotonsillectomy) and other non-surgical options.
“Dr. Isaiah utilized sophisticated data analytics to examine over one million data points, assessing the impact of sleep-disordered breathing on the developing brains of children through adolescence,” said Mark T. Gladwin, MD, who is the John Z. and Akiko K. Bowers Distinguished Professor and Dean of UMSOM, and Vice President for Medical Affairs at University of Maryland, Baltimore.
“With novel computational and AI tools now available at the UM Institute for Health Computing, calculations that once took months can now be completed in a matter of days.”
The research team plans to further utilize AI capabilities at UM Institute for Health Computing to process larger datasets and examine the causal relationship between snoring and brain outcomes.
Funding: The study was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) and the various funders of the ABCD study.
About this sleep, neurodevelopment, and behavioral neuroscience research news
Author: Holly Moody-Porter
Source: University of Maryland
Contact: Holly Moody-Porter – University of Maryland
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Cognitive and Behavioral Outcomes of Snoring Among Adolescents” by Amal Isaiah et al. JAMA Network Open
Abstract
Cognitive and Behavioral Outcomes of Snoring Among Adolescents
Importance
Snoring is central to sleep-disordered breathing (SDB), which arises from nocturnal upper airway resistance. Habitual snoring is associated with cognitive and behavioral problems in young children, but less is known about these associations in adolescents.
Objective
To assess the longitudinal associations of snoring with cognition and problem behaviors among adolescents.
Design, Setting, and Participants
This cohort study was a secondary analysis of the Adolescent Brain Cognitive Development (ABCD) Study dataset (release 5.0), which enrolled 11 875 children and a parent or caregiver from June 1, 2016, to October 15, 2018, at 21 participating US research institutions and followed-up for 5 years. The analysis was performed between December 2023 and April 2024.
Exposures
Parent-reported snoring categorized as none, nonhabitual (<3 nights/week), and habitual (≥3 times/week).
Main Outcomes and Measures
Cognition was assessed using 5 measures from the National Institutes of Health Toolbox (NIH-TB), and caregiver-reported problem behaviors were assessed using the Child Behavior Checklist (CBCL), including Total Problems, Internalizing Problems, and Externalizing Problems. Longitudinal associations of snoring with these assessment measures were analyzed using linear mixed-effects models stratified by obesity.
Model fits were assessed after including the fixed-effects of age, sex at birth, race, family income, follow-up time, visit type, and the random-effects of site and identification number.
Results
The study included data from 11 862 children at year 1 (mean age, 119.0 months [95% CI, 118.8 to 119.1 months]; 6164 male [52.2%]) and 11 198, 10 870, 10 064, and 4668 children at years 2 to 5, respectively. The proportion of habitual snorers decreased from 811 participants (6.8%) in year 1 to 150 participants (3.2%) in year 5. Snoring was not associated with any of the NIH-TB scores.
A statistically significant association of snoring was identified with all CBCL scales. The largest-magnitude association was of snoring with the CBCL Total Problems scale among adolescents with obesity (β = 3.18; 95% CI, 2.59-3.77).
Conclusions and Relevance
In this cohort study analyzing associations of snoring with cognitive test scores and problem behaviors based on the ABCD dataset, the prevalence of snoring declined over time; snoring in adolescents was associated with problem behaviors but not cognitive deficits.
These findings may aid shared decision-making regarding treatment options such as adenotonsillectomy for adolescents with SDB.
