If your child has trouble breathing during sleep, enlarged tonsils may be to blame according to a new study by a sleep specialist. As this ScienCentral News video explains, he also found that troubled breathing at night may be linked to behavioral problems during the day.
Eleven-year-old Azjanae Fields used to wake up in the middle of the night feeling like she was choking. "It was scary because I thought I was dying or something," she says. "I didn't know what was wrong with me. I just would wake up choking."
The sleeping problems spilled over to the daytime, when she would nod off during class and take naps immediately after returning home from school. Doctors told her that her enlarged tonsils getting in the way of her air supply at night.
University of Michigan sleep researcher Ron Chervin says that more subtle symptoms, like snoring, can also signal breathing problems that might be caused by enlarged tonsils. He says that typically children from two to 12 years old don't snore regularly, except when they have a cold.
Enlarged tonsils or adenoids, both types of soft tissue around the throat, can cause sleep apnea, a condition when the throat closes, partially or fully, while a person is sleeping.
Tonsillectomies, while historically thought of as a procedure just for recurrent infection, are the most common way to treat suspected sleep apnea, according to Chervin. He says prior research also showed a connection between sleep disorders and behavior problems. "Disrupting sleep, which is important for the brain, leads to abnormal behavior during the day," he says.
Chervin compared 78 children whose doctors had already scheduled for tonsillectomies to 27 children scheduled for unrelated surgeries.
Running a gamut of tests, volunteers for the study were tested in an overnight sleep laboratory, their behavior was evaluated by a child psychiatrist and their own parents, and they were given cognition tests on a computer. He found that kids in the tonsillectomy group were more likely to be diagnosed with sleep disorders and with attention deficit hyperactivity disorder, or ADHD. When Chervin caught up with the children a year later, he found no significant differences between the two groups. He says that's because, in the tonsillectomy group, "there had been a notable improvement in attention, improvement in hyperactivity, less sleepiness."
Chervin theorizes that disturbed breathing due to enlarged tonsils causes a child to wake up throughout the night, consciously or unconsciously. "Some of our own research has suggested that there may be a little bit of arousal in the brain with each labored breath, even when the throat isn't closing ... we always assume that snoring wakes up everyone else except for the snorer, but that may not be completely true," he says.
This continued lack of sleep could have serious implications for daytime behavior. This can be seen in the daytime sleepy behavior in children, Chervin says, but it can also manifest itself as hyperactive behavior. "Children have a strong drive to stay awake and learn during the day," he says. "They'll do so even if they're sleepy. Even if it means having to shift their attention, create commotion, create artificial stimuli in their environment to stay awake."
Chervin stresses that this was an observational study, where he observed patterns in children whose tonsillectomies were already scheduled. Therefore, these results do not show cause and effect. But, Chervin says, "Our results put us one step further towards saying that sleep apnea is causing those abnormal behaviors."
"I don't think our research is any kind of clarion call to have parents take their children to have their tonsils out," Chervin says. He says that if a child has behavioral problems and has problems sleeping, then those concerns should be brought up with a pediatrician or sleep specialist.
Richard Rosenfeld, a pediatric ear, nose, and throat doctor with Long Island College Hospital, agrees. "We don't want to promote the concept of operating on every child with big tonsils and snoring," he says.
While he was not involved in this study, Rosenfeld, who also serves as a spokesman for the American Academy of Pediatrics, says that he sees value in this research. "Are they having any behavior issues at home or in the classroom … if they are and on top of that they have big tonsils and snoring and disturbed sleep, then these are kids that really become candidates for tonsillectomy," he says.
Azjanae Fields recalls how she was nervous about having her tonsils out, but the end results were positive for her. She quickly noticed changes not only at night, but also during the day. "I could stay awake, I could do more activities, I could hang like the rest of the kids! I don't feel weird no more that I have to sleep a lot."
Chervin and Rosenfeld say that parents should not only pay close attention to their children's behavior during the day, but also at night. Any concerns about labored breathing should be discussed with a pediatrician.
Chervin's research is funded by the National Institutes of Health, particularly the National Institute for Child Health and Human Development, the National Heart Lung and Blood Institute, the National Institute of Neurological Disorders and Strokes. It is also funded by the General Clinical Research Center at the University of Michigan. His work was featured in the July edition of Discover magazine and his paper was published in the April issue of the journal Pediatrics.