Bumpy road to dreamland

> Parents should take note of even minor sleep problems their children may have, which can lead to cognitive difficulties in school

WE ALL know that a good night’s sleep is important, but from snoring to nighttime waking, sleepwalking to insomnia, sleep problems in childhood are common.

Sleep has many roles, from supporting the development of the brain and strengthening neural pathways, to helping the immune system.

Disrupted sleep leads to multiple physical and psychological problems.

Even in infancy and very early childhood, sleep problems are related to poorer mental and motor development.

Therefore, by the time children start school, those with sleep problems are already falling behind their classmates.

Around 20% to 30% of children are thought to experience some kind of sleep problem.

One of the most common is sleep-disordered breathing, which ranges from snoring, to full-blown obstructive sleep apnoea syndrome (OSA).

This is a disorder where the upper airway becomes blocked, which causes difficulty breathing during sleep. While around 12% of children snore, only around 3% suffer from OSA.

Children who do have OSA usually wake up a lot during the night because they are struggling to breathe.

They might also have severe dips in their blood oxygen levels caused by the pauses in breathing. This reduces oxygen delivery to tissues and cells in the body – including the brain.

Having this type of sleep problem has been shown to cause cognitive difficulties, which can impact children’s ability to think, pay attention, process information and remember things.

Research has also shown that children with sleep-disordered breathing have lower IQs, and tend to do less well at school.

A study published in the Journal of Intellectual Disability Research looked at the effects of sleep-disordered breathing on cognitive development in 44 children aged between two and four – 22 of whom had Down’s syndrome.

People with Down’s syndrome often experience OSA due to physical characteristics like low muscle tone, smaller airways and large tonsils or adenoids.

They also experience cognitive and behavioural difficulties, which might be related to sleep problems.

Researchers at Coventry University’s Faculty Research Centre for Psychology, Behaviour and Achievement measured children’s language, motor and visual skills.

They also asked their parents about the children’s language ability and behaviour.

Parents then took home equipment to measure their child’s breathing, heart rate and oxygen levels during sleep.

It was found that in the typically developing group, children whose oxygen levels dipped the lowest during sleep had the poorest expressive language skills, meaning they had more difficulty putting their thoughts into words and sentences.

Those with sleep-disordered breathing also had the poorest behaviour. Their parents reported less pro-social behaviour – like being kind and helping people – and more behavioural problems.

None of the children experienced severe OSA, so research showed that sleepdisordered breathing is sufficient to cause cognitive difficulties in otherwise healthy children – even at the mild end of the spectrum.

This is important, as mild OSA in children often goes unnoticed or unrecognised, and at the moment there is no consensus on the level of severity at which it should be treated.

Children who slept for longer were found to have fewer emotional symptoms such as fears, nervousness and unhappiness.

Previous research has shown that treatment of sleep problems in children usually leads to an improvement in emotional symptoms.

It has even been found that childhood sleep problems can predict anxiety disorders in adulthood.

Findings for children with Down’s syndrome, however, were inconsistent.

With this group, researchers found those who experienced sleep-disordered breathing actually had better language understanding, and used more actions and gestures to communicate.

These children also slept for longer than the typically developing children, so it is possible this protected them from the harmful effects of sleep-disordered breathing.

What all this shows is that sleep is probably just one factor among many that can help or hinder children’s cognitive development.

Nevertheless, the findings show a link between even mild sleep problems and a cognitive disadvantage.

Therefore it is important that we treat sleep problems early, as this might well be the difference between make or break when it comes to schooling. – The Independent