Persistent snoring linked to behavior problems

Persistent, loud snoring in children aged 2 to 3 years is significantly associated with behavior problems, a new study reports.

Previous studies have linked persistent snoring, which affects 9% of children aged 2 to 3 years, to behavior problems at school age. To further explore the relationship between snoring and cognitive and behavioral development and discover variables that may predict transient and persistent snoring, researchers followed 249 children aged 2 to 3 years participating in an ongoing prospective birth cohort study.

Using validated measures, the researchers compared cognitive and behavioral functioning in nonsnorers, transient snorers (whose parents reported that they snored loudly 2 or more times a week at either 2 or 3 years of age), and persistent snorers (who snored 2 or more times a week at both 2 and 3 years).

Multivariate analysis revealed significantly higher rates of behavior problems, especially hyperactivity, inattention, and depression, among persistent snorers than transient snorers and nonsnorers.

Differences in cognitive scores among the 3 groups were not significant after adjusting for demographic variables, nor did the groups differ significantly in motor development.

Lower socioeconomic status and absence or shorter duration of breastfeeding were the most robust predictors of transient and persistent snoring. None of the children who were breastfed for longer than 12 months developed persistent snoring compared with almost 25% of children who were never breastfed or breastfed for less than 1 month. Black race was also a risk factor and, a secondary analysis suggests, may influence an association between snoring and childhood exposure to tobacco smoke.

The study results support routine screening for snoring, as recommended by the American Academy of Pediatrics, especially for children from lower socioeconomic backgrounds. Following children who snore to see whether the snoring persists is important, because previous research suggests that treatment of sleep-disordered breathing may reverse behavioral and medical morbidity. The study also highlights the need to encourage and facilitate breastfeeding.

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