Kids' snoring could signal obstructive sleep apnea, guidelines say

<br>CHICAGO (AP) _ Snoring in children may be a sign of obstructive sleep apnea, a common but under-diagnosed condition that has been linked to learning problems, slow growth and even bed-wetting and high

Monday, April 1st 2002, 12:00 am

By: News On 6

CHICAGO (AP) _ Snoring in children may be a sign of obstructive sleep apnea, a common but under-diagnosed condition that has been linked to learning problems, slow growth and even bed-wetting and high blood pressure, new pediatricians' guidelines say.

All children's routine checkups should include questions about snoring to better diagnose the syndrome, which can often be cured by surgery to remove tonsils and adenoids, according to the guidelines from the American Academy of Pediatrics.

While snoring can be harmless in some children, it is also one of the most common symptoms of the disorder. Studies suggest about half a million children ages 2 to 8, the most vulnerable ages, are affected. Sleep experts say that likely is an underestimate because many parents and pediatricians may dismiss snoring as just an annoying habit.

``Parents should be aware that snoring is not necessarily a normal phenomenon for their children and they should discuss it with their doctors,'' said Dr. Carole Marcus, director of Johns Hopkins University's pediatric sleep center and head of the academy committee that wrote the guidelines.

The guidelines _ the academy's first on obstructive sleep apnea _ are published in the April issue of the academy's medical journal, Pediatrics.

The disorder is often associated with enlarged tonsils and adenoids as well as relaxation or decreased muscle tone in the upper airway _ soft tissue at the back of the throat _ during sleep.

Labored, noisy breathing and brief breathing lapses may occur, resulting in restless sleep although children usually don't awaken fully during the spells.

Obstructive sleep apnea can result in daytime tiredness, which may make children act up or have learning difficulties. Some studies have even suggested affected children may be misdiagnosed with attention deficit disorders, or may have slow physical growth. Bed-wetting in older children and mildly high blood pressure are less common symptoms.

Affected children may have nasal-toned voices or openmouthed expressions due to mouth-breathing, but an overnight sleep study is needed for a definitive diagnosis, the guidelines say.

Surgery to remove tonsils and adenoids should be the first line of treatment and can resolve many of the symptoms, the guidelines say. Research has suggested that behavior and learning problems improve after the operation, and children also often have a growth spurt afterward. Other symptoms usually disappear after surgery, Marcus said.

Dr. Stephen Sheldon, a sleep specialist at Children's Memorial Hospital in Chicago, called the guidelines ``a tremendous step forward'' that means many children who would have been mislabeled with learning or behavior problems will get a correct diagnosis.

The connection with obstructive sleep apnea and such problems ``really has gone unrecognized, until now,'' Sheldon said.