Sleep Problems May Lower Child’s Grades

September 10, 1998

NEW YORK (Reuters) -- Many children who do poorly in school have sleep problems that leave them drowsy during the day. These children may do better academically once these problems are treated, results of a study suggest.

In light of these findings, parents and physicians should consider sleep problems in children who are not performing well in school, concludes Dr. David Gozal of Tulane University School of Medicine in New Orleans, Louisiana. According to Gozal, this study, which is published in the September issue of Pediatrics, is the first to examine the effect of pronounced sleep problems on children’s academic performance.

Gozal studied 297 first-graders who had been ranked in lowest 10% of their classes. to determine whether the children had sleep-disordered breathing -- problems that can severely disrupt sleep, and cause daytime sleepiness -- he asked their parents to complete questionnaires about their children’s sleep habits.

Among other things, parents were asked whether their children snored, and whether they ever showed signs of struggling to breathe while asleep. These symptoms may indicate obstructive sleep apnea syndrome, a serious disorder. People with sleep apnea stop breathing temporarily while asleep, fail to get adequate rest, and are tired during the day.

Gozal also used a pulse oximeter device to check blood oxygen levels in children while they slept. Preliminary research has suggested that low blood oxygen levels may be an indicator of sleep apnea.

Of the study participants, 66 (22%) snored, and 54 (18%) had blood oxygen levels suggestive of sleep apnea, Gozal reports. Enlarged tonsils, or adenoids -- which can obstruct the airway when the child is lying down -- are often the culprit in apnea. In these cases, surgical removal of the adenoids and tonsils usually resolves the problem.

The parents of 24 children whose blood test results suggested apnea opted to have their children undergo the surgery. All of these children did better in school after the surgery, reports Gozal, who checked the children’s school records a year later. On average, the children’s grades increased, rising from 2.43 to 2.87 on a scale of 0 to 4 where 2 is a minimal passing grade. In the “not surgically treated” group, no statistically significant improvement occurred in grades the following year.

“The significant improvement in school performance in the treatment group demonstrates that some component of the learning difficulties exhibited by these children is attributable to sleep-disordered breathing,” Gonzal concludes. “It is therefore recommended that sleep-related symptoms should be actively sought in children with developmental or learning problems and that referral for evaluation of sleep-disordered breathing should occur early rather than late.”

An estimated 1% to 2% of children may have obstructive sleep apnea, according to previous research.

Source: Pediatrics 1998;102:616-620, Reuters Health Information Services

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