Children with sleep-disordered breathing (SDB) or abnormal breathing during their sleep can develop serious behavioral difficulties such as hyperactivity, aggressiveness, emotional symptoms and peer relationship difficulties, says a new study.

The study conducted by the Albert Einstein College of Medicine of Yeshiva University had analyzed more than 11,000 children for over six years and published the data that supported and proved their findings.

The new research gives strong evidences, unlike the previous ones that involved very small group of patients with short follow ups and were not fully dependable.

Dr Karen Bonuck, who led the study, says children with sleep-disordered breathing problems have 40-100 percent more chances to develop neurobehavioral problems by age 7, compared to children without having breathing problems.

The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures, says Dr Bonuck in his paper, titled Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.

The researchers studied the combined effects of snoring, apnea (abnormally long pauses in breathing during sleep) and mouth-breathing patterns on the behavior of children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

Even though snoring and apnea are common in children, the pediatricians or family physicians do not routinely check or diagnose the symptoms. The parents of children showing one or two breathing problems during their sleep should seek their pediatrician's advice about consulting an otolaryngologist (ear, nose and throat physician) or sleep specialist, the study suggests.

The SDB is caused by enlarged tonsils or adenoids. It affects the brain in several ways and leads to behavioral problems. It brings the oxygen levels down and increases carbon dioxide level in the prefrontal cortex, interrupting the restorative processes of sleep and disrupting the balance of various cellular and chemical systems. It negatively affects the brain and leads to impairments in executive functioning (ability to pay attention, plan ahead and organize), the ability to suppress behavior, and the ability to self-regulate emotion and excitement.

The SDB also occurs in younger children, but goes up from two to six years of age. About 1 in 10 children snore regularly and 2 to 4 percent have sleep apnea, according to the American Academy of Otolaryngology­- Health and Neck Surgery (AAO-HNS).

The AAO-HNS suggests surgery as the first-line treatment for severe pediatric SDB in cases where the tonsils and adenoids are enlarged. Weight loss is recommended for overweight or obese children.

Behavioral assessment was based on the Strengths and Difficulties Questionnaire (SDQ), answered by parents. The SDQ contained issues related to a child's inattention/hyperactivity, emotional symptoms (anxiety and depression), peer problems, conduct problems (aggressiveness and rule-breaking), and pro social behavior (sharing, helpfulness, etc).