Snoring in adolescents linked with problem behaviors but not cognitive deficits

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. 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."

Amal Isaiah, MD, PhD, MBA, study co-author, Chief of Pediatric Otorhinolaryngology at UMSOM and faculty at the Institute for Health Computing

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.

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.

UMSOM is one of 21 research sites involved in the ABCD study and faculty, including Dr. Isaiah, are co-investigators on this ongoing research. Study co-authors Linda Chang, MD, MS and Thomas Ernst, PhD are site principal investigators.