Study links structural brain changes to behavioral problems in children who snore
April 13, 2021
Science Daily/NIH/National Institute on Drug Abuse
A large study of children has uncovered evidence that behavioral problems in children who snore may be associated with changes in the structure of their brain's frontal lobe. The findings support early evaluation of children with habitual snoring (snoring three or more nights a week). The research, published in Nature Communications, was supported by the National Institute on Drug Abuse (NIDA) and nine other Institutes, Centers, and Offices of the National Institutes of Health.
Large, population-based studies have established a clear link between snoring and behavioral problems, such as inattention or hyperactivity, but the exact nature of this relationship is not fully understood. While a few small studies have reported a correlation between sleep apnea -- when pauses in breathing are prolonged -- and certain brain changes, little is known about whether these changes contribute to the behaviors seen in some children with obstructive sleep-disordered breathing (oSDB), a group of conditions commonly associated with snoring that are characterized by resistance to breathing during sleep.
To address this knowledge gap, researchers led by Amal Isaiah, M.D., D.Phil., of the University of Maryland School of Medicine, capitalized on the large and diverse dataset provided by the Adolescent Brain Cognitive Development (ABCD) Study, a long-term study of child health and brain development in the United States. The team of researchers mined this wealth of data from more than 11,000 9- and 10-year-old children to examine the relationships among snoring, brain structure, and behavioral problems.
Confirming the results of previous work, their statistical analysis revealed a positive correlation between habitual snoring and behavioral problems, with the children who most frequently snored generally exhibiting worse behavior according to an assessment completed by parents. The findings further showed that snoring is linked to smaller volumes of multiple regions of the brain's frontal lobe, an area involved in cognitive functions such as problem solving, impulse control, and social interactions. The statistical analysis also suggested that the brain differences seen in children who snore may contribute to behavioral problems, but additional work on how snoring, brain structure, and behavioral problems change over time is needed to confirm a causal link.
This study's findings point to oSDB as a potential reversible cause of behavioral problems, suggesting that children routinely be screened for snoring. Children who habitually snore may then be referred for follow-up care. Such care may include assessment and treatment for conditions that contribute to oSDB, such as obesity, or evaluation for surgical removal of the adenoids and tonsils.
The ABCD Study, the largest of its kind in the United States, is tracking nearly 12,000 youth as they grow into young adults. Investigators regularly measure participants' brain structure and activity using magnetic resonance imaging (MRI) machines, and collect psychological, environmental, and cognitive information, as well as biological samples. The goal of the study is to define standards for normal brain and cognitive development and to identify factors that can enhance or disrupt a young person's life trajectory.
https://www.sciencedaily.com/releases/2021/04/210413081406.htm
Medicinal cannabis may reduce behavioral problems in kids with intellectual disabilities
June 24, 2020
Science Daily/Murdoch Childrens Research Institute
Cannabidiol, a type of medicinal cannabis, may reduce severe behavioural problems in children and adolescents with an intellectual disability a new study has found.
The pilot study, led by the Murdoch Children's Research Institute (MCRI) and published in the British Journal of Clinical Pharmacology, recorded a clinically significant change in participants' irritability, aggression, self-injury, and yelling. The intervention was also found to be safe and well-tolerated by most study participants.
The randomised controlled trial involved eight participants, aged 8-16, years who took either cannabidiol or a placebo over eight weeks. Participants were recruited from paediatric clinics from both hospital and private paediatric practices.
Although the pilot study was not large enough to make definitive statements, the early findings strongly support a larger follow-up trial. Only a large scale randomised controlled trial can produce the definitive results necessary to drive changes in prescribing and clinical care guidelines. The researchers are planning a large study to definitively test the findings.
The researchers are also seeking funding for further research into the effectiveness of medicinal cannabis in children with developmental disorders such as autism and Tourette syndrome.
Associate Professor Daryl Efron, a clinician-scientist at MCRI who led the study, said this was the first investigation of cannabidiol to manage severe behavioural problems in children and adolescents with an intellectual disability. Most of the participants also had autism.
The study found the medication was generally well-tolerated and there were no serious side effects reported. All parents reported they would recommend the study to families with children with similar problems.
Associate Professor Efron said severe behavioural problems such as irritability, aggression and self-injury in children and adolescents with an intellectual disability were a major contributor to functional impairments, missed learning opportunities and reduced quality of life.
He said conventional psychotropic medications, including anti-psychotics and anti-depressants, were prescribed by Australian paediatricians for almost half of young people with an intellectual disability, despite limited evidence of their effectiveness. Given how extremely difficult behavioural problems were to treat in these patients, new, safer interventions were needed to treat this highly vulnerable patient group, he said.
"Current medications carry a high risk of side-effects, with vulnerable people with intellectual disability being less able to report side-effects," he said. "Common side-effects of antipsychotics, such as weight gain and metabolic syndrome, have huge health effects for a patient group already at increased risk of chronic illness."
Cannabidiol is already being used increasingly to manage a range of medical and psychiatric conditions in adults and epilepsy in children.
Associate Professor Efron said there was intense interest from parents and physicians in medicinal cannabis as a treatment for severe behavioural problems in youth with an intellectual disability.
"Parents of children with an intellectual disability and severe behavioural problems are increasingly asking paediatricians whether they can access medicinal cannabis for their child and some parents have reported giving unregulated cannabis products to their children," he said.
"We are also finding many physicians feel unprepared to have these conversations with their patients." Researchers from The Royal Children's Hospital, the University of Melbourne and Monash University also contributed to the study.
https://www.sciencedaily.com/releases/2020/06/200624100039.htm