Sleep or die -- growing body of research warns of heart attacks, strokes

Updated recommendations from the American Academy of Sleep Medicine regarding appropriate sleep time should be reviewed carefully.  Too little sleep is consistently associated with increased medical risk. Dr. Susarla

We have all experienced the aftermath of a bad night's sleep: grogginess, irritability, difficulty carrying out even the simplest of tasks. A growing amount of research suggests that not getting enough shut-eye could also have insidious effects on heart disease, obesity and other conditions.

The American Academy of Sleep Medicine, the largest physician-based organization for sleep medicine, recently put out their first recommendations for what is the right amount of sleep. It advises that adults get at least seven hours every night based on research on the link between inadequate sleep and a number of poor health outcomes. 

Although most of us already know that we should get at least seven hours of sleep, a study last month suggested that Americans are creeping down to that cutoff. The average amount of sleep that they reported getting a night has dropped from 7.4 hours in 1985 to 7.29 hours in 1990 to 7.18 in 2004 and 2012. 

The Centers for Disease Control and Prevention, which requested and helped support the development of the current recommendations, has called not getting enough sleep a public health epidemic.

Read article here.

Sugar doesn’t make kids hyper, and other parenting myths

Sugar, shoes, sleep, baby Mozart....parenting is hard enough without added "wisdom". Our oldest has come to understand that we have a

learning curve. JR

Baby shoes didn’t feature prominently into Baby V’s wardrobe for quite some time. Tiny Chuck Taylors are adorable, obviously, but I questioned their utility for a baby who didn’t use her feet except as wiggly pacifiers. So Baby V spent a lot of time barefoot — a fashion statement that I didn’t really consider until she started toddling around in public. 

Well-meaning observers were quick to tell me that I needed to get that baby some nice stiff shoes. Hard soles will help her get the hang of walking and protect her delicate baby feet, I was told. But when I started looking into this advice, I actually found the opposite is true: These days, people recommend that babies learning to walk wear soft, flexible shoes, or better yet, go barefoot. The minimalist footwear allows the nascent walkers the most sensory feedback from their sweet little feet as they move across the earth.

I offer the shoe advice as just one tiny glimpse into the life of a parent of a young kid. Over the last year, I’ve come to learn that much of the advice I’ve heard, while well-intentioned, might just be wrong. Or at the very least, questionable. So here are my top five parenting myths (shoes didn’t make the cut), with a little dash of science.

1. Sugar makes kids hyper.

Lots of parents swear that a single hit of birthday cake holds the power to morph their well-behaved, polite youngster into a sticky hot mess that careens around a room while emitting eardrum-piercing shrieks. Anyone who has had the pleasure to attend a 5-year-old’s birthday party knows that the hypothesis sounds reasonable, except that science has found that it’s not true.

Sugar doesn’t change kids’ behavior, a double-blind research study found way back in 1994. A sugary diet didn’t affect behavior or cognitive skills, the researchers report. Sugar does change one important thing, though: parents’ expectations. After hearing that their children had just consumed a big sugar fix, parents were more likely to say their child was hyperactive, even when the big sugar fix was a placebo, another study found.

Of course, there are plenty of good reasons not to feed your kids a bunch of sugar, but fear of a little crazed sugar monster isn’t one of them.

2. Listening to Mozart makes babies smarter.

My colleague Rachel Ehrenberg busted this “Mozart Effect” myth in her 2010 feature. The original observation, that 10 minutes of classical music made college students briefly perform better on a paper-folding task, was twisted so out of context that the governor of Georgia used tax money to buy a classical music CD for every baby born in the state.

Many babies adore music, and there’s evidence that suggests music might help soothe babies. There’s also evidence that playing an instrument might be beneficial to brain development, as Ehrenberg points out. But scientists haven’t found that classical music makes your baby smarter. So play music to your child because she loves it and you love it, not because you’re looking to grub a few extra IQ points.

3. Feeding a baby solid food will help her sleep through the night.

Your baby is waking up in the night? Just put some rice cereal in the last bottle before bed, well-intentioned observers urge. The solid food will fill baby’s tummy and keep her satisfied longer, which translates to fewer wakeups. Except that it doesn’t.

Babies fed rice cereal before bedtime slept no better than babies fed only breast milk or formula, a study found. In fact, early introduction to solid food (before 4 months) has been associated with worse infant sleep.  The magical cure of feeding a baby solids before bedtime belongs at the top of the heaping pile of sleep miracles that sound great but don’t really work. And speaking of rice cereal…

Full Article HERE

Why might this be? Children with allergies and asthma are known to have elevated risk of sleep disturbance, which could manifest with snoring in those with allergies, increased cough and respiratory symptoms during sleep for poorly controlled asthma. And finally, poor sleep quality can lead to symptoms of ADHD. Dr. Susarla

Children With Allergy, Asthma May Be at Higher Risk for ADHD

 The number of children being diagnosed with attention-deficit disorder (ADHD), allergy and asthma is increasing in the United States. And according to a new study, there might be a link between the growth of these three conditions.

The study, published in the August issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), found there is an increased risk of ADHD in boys that have a history of allergy or asthma.

"ADHD, a chronic mental health disorder, is most commonly found in males, while asthma is also more common in young boys than girls," said Eelko Hak, lead study author. "We found there is an increased risk of ADHD in boys with a history of asthma and an even stronger risk associated with milk intolerance."

Researchers in the Netherlands and Boston studied 884 boys with ADHD and 3,536 boys without the disorder. Of the children with ADHD, 34 percent had asthma and 35 percent had an allergic disorder. The study suggests medications used to treat these conditions may be associated with an increased ADHD risk.

"Further research is needed to understand why there appears to be an increased risk of developing ADHD in children with allergy and asthma," said Gailen Marshall, MD, editor-in-chief of Annals of Allergy, Asthma & Immunology. "Medications for these conditions far outweigh the risks, and can be life-saving in some conditions. Treatment should not be stopped, unless advised by a board-certified allergist."

According to the ACAAI, allergy and asthma often run in families. If both parents have an allergy a child has a 75 percent chance of being allergic. If neither parent has allergy, the chance of a child developing an allergy is only 10 to 15 percent. Allergists also know allergies and asthma are linked. An estimated 60 to 80 percent of children with asthma also have an allergy. While the cause of ADHD is unknown, this disorder is also thought to run in families
.

Read article here.

ATS: Adenotonsillectomy Offers Relief to Kids With Sleep Apnea

Are some cognitive deficits associated with obstructive sleep apnea inevitable, or are we not detecting this problem early enough? Dr. Susarla

ATS: Adenotonsillectomy Offers Relief to Kids With Sleep Apnea

TUESDAY, May 21 (HealthDay News) -- Compared to watchful waiting, early adenotonsillectomy improves some symptoms, but not attention or executive function, in school-age children with obstructive sleep apnea syndrome, according to a study published online May 21 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 17 to 22 in Philadelphia.

Carole L. Marcus, M.B., B.Ch., from the Children's Hospital of Philadelphia, and colleagues randomized 464 children (aged 5 to 9 years) with obstructive sleep apnea syndrome to either early adenotonsillectomy or watchful waiting. At baseline and after seven months, polysomnographic, cognitive, behavioral, and health outcomes were assessed.

The researchers found that the change in attention and executive function score on the Developmental Neuropsychological Assessment did not significantly differ between study groups (mean improvement, 7.1 in the early-adenotonsillectomy group and 5.1 in the watchful-waiting group). In the behavioral, quality-of-life, and polysomnographic findings, there were significant reductions in symptoms in the early-adenotonsillectomy group. A larger proportion of children in the intervention group had normalization of polysomnographic findings than did in the watchful waiting group (79 versus 46 percent).

"As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by means of neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy," the authors write.

Read article here.

Snoring Kids Should Be Screened for Sleep Apnea

It's nice to see media outlets covering this important health issue for children.  The AAP has rightfully updated an outdated guideline given the dangers of untreated sleep apnea. Dr. Susarla

AAP Issues New Guidelines for Kids’ Snoring

ABC News Medical Unit

A new set of practice guidelines released Monday by the American Academy of Pediatrics (AAP) may help parents and pediatricians uncover things that go snore in the night.

Pediatric sleep experts focused on children with a condition known as uncomplicated obstructive sleep apnea, which occurs when breathing is interrupted during sleep and is related to enlarged tonsils or obesity.  It is a condition the AAP says affects 1.2 to 5.7 percent of American children. They reviewed evidence from 350 study articles between 1999 and 2010 to create the following recommendations:

• Screening: All children and adolescents should be screened for snoring at their routine health visits.
• Sleep testing: Any children who have symptoms of obstructive sleep apnea, such as habitual snoring, disturbed sleep from intermittent pauses, snorts or gasps, or daytime behavioral problems, should be referred for a sleep study.
• Adenotonsillectomy: Any child with obstructive sleep apnea and enlarged tonsils should be referred to a surgeon to consider tonsil removal surgery.
• High risk: A child undergoing tonsil surgery is considered “high-risk” if he or she is under age 3, has severe sleep apnea on sleep testing, is obese or currently has an infection. These children should be closely monitored in the hospital after surgery for any complications.
• Re-evaluation: After surgery, snoring children should be reassessed to see if their sleep apnea has improved or if they will need any further treatments.
• CPAP: If symptoms do not improve after surgery or if a child is unable to get surgery for some reason, they should be considered for CPAP (continuous positive airway pressure), which is a breathing apparatus, often worn at night, that keeps airways open.
• Weight loss: Weight loss is recommended for any overweight or obese patient in addition to any other treatments.
• Intranasal steroids: Nasal sprays are recommended for patients with mild sleep apnea symptoms, whether in lieu of or after tonsil surgery.

The last set of guidelines for pediatric sleep apnea was released in 2002. The changes reflected in these new guidelines were made in light of research over the past 10 years that has suggested that delayed diagnosis of childhood sleep apnea “can result in severe complications if left untreated,” according to the American Academy of Pediatrics report. Examples include cognitive deficits, behavior problems, hypertension and heart problems, failure to thrive and inflammation throughout the body.

With these new guidelines, the AAP hopes that more cases of childhood sleep apnea will be diagnosed sooner and children will receive the proper treatments earlier to prevent these dangerous long-term effects.

“These new guidelines are extremely important,” says Dr. Vikas Jain, a sleep specialist at Integris Health in Oklahoma City.

“Pediatric sleep apnea is a rising problem among American children and leads to serious consequences,” he says. “The sooner we can diagnose a child with this condition, the sooner we can get these kids started on the right treatments to improve their quality of life and their overall health.”

Read article here.

Asthma Drug May Help Kids Avoid Sleep Apnea Surgery

This is an interesting article from Web MD about an upcoming paper to be published in the journal Pediatrics.  The "small" and "preliminary" nature of this study should be emphasized.  Also, home sleep testing is mentioned here.  However, this is not an accepted test in children.  Dr. Susarla

Asthma Drug Helps Kids Avoid Sleep Apnea Surgery?

Small Study Suggests Singulair Can Improve Sleep Apnea Symptoms in Some Kids

Aug. 7, 2012 -- A new study suggests that a common asthma drug may be able to help children with sleep apnea avoid surgery.

Children with obstructive sleep apnea may be tired by day, have trouble paying attention in school, and have other behavioral problems because they are not getting enough quality sleep at night.

Surgery to remove the tonsils and adenoids is often recommended, but many parents are reluctant to subject their kids to any type of surgery.

New research in the September 2012 issue of Pediatrics suggests an allergy andasthma drug -- montelukast (Singulair, which just went generic) -- may lessen symptoms in children with non-severe apnea and potentially allow them to skip the surgery.

Sleep apnea is marked by pauses in breathing while asleep. Sleep apnea is often a result of an obstruction in the airway, with severity of children's sleep apnea linked to the size of tonsils and adenoids. These pauses can occur throughout the night and disrupt sleep.

Asthma Drug Improves Apnea Symptoms

Forty-six children with non-severe sleep apnea received the asthma drug or aplacebo for 12 weeks. The kids who received the drug showed improvements in tests measuring the degree of their sleep apnea, their sleep-related symptoms, and the size of their adenoids compared to their counterparts who didn't. There were no side effects seen among kids who took the study drug.

Study authors are quick to caution that this study is small and it's preliminary. Bigger studies following more children for longer periods of time are needed before this treatment is offered to any kids with sleep apnea.

Michael Rothschild, MD, also urges caution in interpreting the new findings. He is the director of pediatric otolaryngology at Mount Sinai Medical Center in New York City.

It's too early to recommend montelukast for the treatment of sleep apnea in kids. But, "it does make sense," he says. "The drug reduces inflammation in the nose and adenoids."

That said, longer follow-up is needed. "Let's do a big, long-term study in a bigger group of kids and follow them for six months or one year."

Until then, if you think your child has sleep apnea, the first step is to confirm this suspicion. "With kids, the risk is not stopping breathing, but more that it is disturbing their sleep," he says.

Sleep apnea in children may be measured in several ways. These include:

• The gold standard sleep study conducted overnight in a lab
• A home sleep study where children are hooked up to a monitor while they sleep
• Videotaping of the child in the throes of what parents believe to be an apnea episode

Drug May Be Band-Aid, Not Cure

Parents also need to know that while no one wants their children to undergo surgery, removal of tonsils and adenoids is safe. "Parents often say 'anything but surgery,' and 99.9% of the time, they are terrified of anesthesia," Rothschild says.

Yosef Krespi, MD, is the director of the Center for Sleep Disorders at the New York Head & Neck Institute of Lenox Hill Hospital in New York City.

He says the allergy and asthma drug may be more of a Band-Aid, but is likely not a cure for sleep apnea in kids. "The follow-up is too short and the number of cases is too limited," he says.

There are often several factors that cause sleep apnea, and this only addresses one of them, he says.

Read article here.

Howie Mandel - America's Got ADHD and OCD

Link to Howie on 20/20 - "Hand rails are my enemy" says "Deal or No Deal" 

By JESSICA HADDAD, ERIC M. STRAUSS (@ericmstrauss) and DAVID MUIR (@DavidMuir)

Nov. 24, 2009

People know Howie Mandel as a comedian, actor and game show host. But what many fans don't know is how much he suffers from a crippling fear of germs -- something he has joked about before, but never spoken seriously about until now.

The 54-year-old "Deal Or No Deal" host suffers from obsessive compulsive disorder or OCD -- a debilitating anxiety disorder that produces inescapable repetitive thoughts.

Like many of the 4 million adults who suffer from OCD, Mandel's most frequent obsession is germs, but can manifest itself in countless ways that trigger a silent loop of the question 'What if...' in his mind.

"I'm always on the verge of death in my head," he told "20/20."

ABC News' David Muir followed Mandel for two weeks behind the scenes on the set of "Deal Or No Deal" in Connecticut, at his beautiful California home, and in his spotless Las Vegas penthouse suite at the MGM Grand, where he performs 40 nights a year.

It is quickly evident that Mandel is a gracious family man who loves to entertain, is living his dream, albeit in constant fear.

On the set, instead of shaking hands, Mandel does the fist bump -- his trademark greeting on "Deal Or No Deal" -- to work around his germ anxiety.

Courtesy Random House

Howie Mandel is going public with his struggle with his OCD in a humorous autobiography entitled, "Here's the Deal: Don't Touch Me," which hits bookstores today.

"In my mind [my hand] is like a petri dish. ... Otherwise I would spend the day, as I have in the past in my life in the men's room rubbing and scrubbing and scalding," he said.

Mandel lays out the fist bumping rules to all the contestants that stick out their hands to meet him on the show. But his OCD goes far beyond that.

Off stage, it's all consuming. His makeup artists must use brand new sponges every day. He won't touch his money unless it's been washed. He avoids hand rails like the plague. "Hand rails are my enemy. I never go near a hand rail," he said. Even Mandel's trademark bald head is this way by choice. "This feels so streamlined and so clean," he said.

At times, his "irrational" fears can strike at the most inopportune moments.

"The biggest fear I have is being triggered," he said. "And if I'm triggered and I get some sort of weird thought in my head that can't go, then my day is, is stopped. My life stops."

Mandel is going public with his struggle with his OCD in a humorous autobiography entitled, "Here's the Deal: Don't Touch Me," which hits bookstores today. He reveals the unusual set of rituals and the terrifying role that OCD consumes in his life.

"I once missed an appointment because I left my house, I locked the door. And then I thought, like anybody else, you know, I don't think I locked the door. I just kept going back to the door. And I couldn't stop myself from checking and checking," he recalls.

Mandel checked the lock 32 times before he took his fist and punched the handle.

"I thought if I felt the pain in the door, then I know for certain. But intellectually, I know I had checked the door. So why am I going back? I can't get past the thought, whether it's thoughts that go into your head. Fears. Thoughts, horrible images, or whatever," he said.

Mandel Battles OCD, ADHD as Kid

Born and raised in Toronto, Mandel grew up in a self-described loving family. As long as he can remember, he had an unhealthy fear of germs. He said kids made fun of him because he couldn't tie his shoes.

"Well, I could, but I didn't want to touch it. But I don't want to say I'm afraid to touch it because it's dirty, so I didn't," he recalled.

Howie Mandel on Dr. Drew

OCD Story part 1


Part 2

Untreated Sleep Apnea and Behavioral Problems in Kids

Parents, don't ignore this association.  There is a convincing connection between sleep apnea and behavioral problems in some children, according to data presented at the 2012 SLEEP conference.  The pertinent question is: Can we prevent this?  Dr S

Sleep Apnea Causes Behavioral Problems in Children that 

Persists Even in Teenage Years

Children with obstructive sleep apnea that remains untreated in teenage years, suffer from long-term behavioral problems.

Children with obstructive sleep apnea (OSA) that remains untreated in teenage years, suffer from long-term behavioral problems, said a new study.

"If left untreated, OSA negatively impacts a youth's ability to regulate their behaviors, emotions and social interactions. These behaviors can interfere with their ability to care for themselves and engage in socially appropriate behaviors – skills that are needed to be successful in school," said Michelle Perfect, lead author of the study.

For the study, researchers studied 263 children who had obstructive sleep apnea. They found that children who had OSA during their teenage years were more likely to suffer from aggression, hyperactivity, difficulty in controlling their behavior and many other social and behavioral problems.

The study was presented at SLEEP 2012.

Obstructive sleep apnea is common in children. According to many studies around 3 to 12 percent of all children snore in their pre-teen years while around 1 to 10 percent of children have obstructive sleep apnea syndrome.

Sleep apnea is characterized by a distinctive "snorting" or gasping noises while sleeping, CDC says.

Disturbed sleep at night makes people tired and restless during daytime.

Previous studies have shown that obese kids are more likely to suffer from breathing disorders. However the latest research has not found any co-relation between BMI, age, sex or race.

According to a study published in the journal Pediatrics, sleep-disordered breathing adversely affects learning performances. The study also says that children who have behavioral problems may have disturbed sleep.

Experts say that any sleep-related disorder must be treated as soon as possible to avoid any long-term health complications.

Read more here

CPAP for Sleep Apnea Reverses Neurobehavioral Problems in Children

Thanks to Dr. Susarla for posting this article! Dr. Rotenberg

Sleep apnea in children results in problems in the way kids function during the day.  For children that need it, this study confirms that CPAP use can REVERSE issues of daytime sleepiness, behavioral problems, and attention deficits.  A CPAP desensitization service that addresses the difficulties of getting started can make the process easier.  Dr. S 

Effects of Positive Airway Pressure Therapy on Neurobehavioral Outcomes in Children with Obstructive Sleep Apnea

Marcus, Carole L; Radcliffe, Jerilynn; Konstantinopoulou, Sofia; Beck, Suzanne E;Cornaglia, Mary Anne; et al. American Journal of Respiratory and Critical Care Medicine185. 9(May 1, 2012): 998-1003.

Abstract (summary)

Rationale: Positive airway pressure therapy is frequently used to treat obstructive sleep apnea in children. However, it is not known whether positive airway pressure therapy results in improvements in the neurobehavioral abnormalities associated with childhood sleep apnea. Objectives: We hypothesized that positive airway pressure therapy would be associated with improvements in attention, sleepiness, behavior, and quality of life, and that changes would be associated with therapy adherence. Methods: Neurobehavioral assessments were performed at baseline and after 3 months of positive airway pressure therapy in a heterogeneous group of 52 children and adolescents. Measurements and Main Results: Adherence varied widely (mean use, 170 ± 145 [SD] minutes per night). Positive airway pressure therapy was associated with significant improvements in attention deficits (P < 0.001); sleepiness on the Epworth Sleepiness Scale (P < 0.001); behavior (P < 0.001); and caregiver- (P = 0.005) and child- (P < 0.001) reported quality of life. There was a significant correlation between the decrease in Epworth Sleepiness Scale at 3 months and adherence (r = 0.411; P = 0.006), but not between other behavioral outcomes and adherence. Behavioral factors also improved in the subset of children with developmental delays. Conclusions: These results indicate that, despite suboptimal adherence use, there was significant improvement in neurobehavioral function in children after 3 months of positive airway pressure therapy, even in developmentally delayed children. The implications for improved family, social, and school function are substantial. Clinical trial registered with www.clinicaltrials.gov (NCT 00458406).

Read full paper here

ADHD and Stuff That's Like It

No doubt ADHD is real, but it can be confused with other conditions including sleep disorders.  SS

Think your child has ADHD? Think again …

“My child is having trouble at school. The teacher says I should ask about ADHD.”  Sound familiar to you? It should.
The diagnosis of ADHD is being made more frequently than ever before. In 2010, a whopping 10 million children were diagnosed with ADHD, which is a 66 percent increase from 10 years ago! What concerns me is that many are being incorrectly diagnosed with ADHD by busy pediatricians who don’t take the time to ask some important questions.
I once had a hyperactive 9-year-old patient with sleep apnea who snored so badly that he would stop breathing dozens of times each night. An operation by the ENT (Ear, Nose and Throat) surgeon cured his apnea and improved his behavior.
So what is ADHD? It stands for “Attention Deficit Hyperactivity Disorder.”  Children with ADHD can be impulsive and often have trouble waiting their turn. They are often forgetful, sloppy with schoolwork and chores, and have short attention spans. They are fidgety, squirmy and can be excessively talkative. Parents describe them as being so active that they seem to be “driven by a motor”.  I know what you’re thinking … don’t all children act like this? Yes, but children with ADHD have severe symptoms that impair the child’s functioning, specifically, their ability to do well in school, make friends and avoid injury due to reckless behavior.
While ADHD treatment is generally safe and very effective, it is important to make sure that we are treating the right condition. With that being said, here are some important questions to consider before visiting your pediatrician:
Does your child get a restful sleep every night? Unlike adults who become groggy and slow after a bad night of sleep, children can become hyperactive and rowdy. Inform your doctor of any sleep disturbances such as frequent nightmares, fidgetiness, bedwetting, trouble falling asleep or trouble staying asleep. Make sure your child gets at least 8-10 hours of sleep each night. 
Does your child behave violently? Do they do things just to spite you? Violent behavior is not a criteria for ADHD. The real question is where did your child learn this behavior? At least once a month I see a child for “ADHD” who lives in a home where one parent is emotionally or physically abusing the other. Children are like sponges that can easily pick up on violent tendencies from their parents, television, movies and video games. Other possibilities to explain violent behavior include oppositional defiant disorder and conduct disorder.
Is your child easily embarrassed? Does he or she have low self-esteem? Is your child a worrier? Again, these are not part of the ADHD criteria. Your child might have depression or anxiety. I know it sounds strange to think that a young child could have depression, but it is more common than you may think.
Does your child misbehave only in school? If so, are there specific teachers, students or situations that seem to elicit this behavior? Perhaps your child has a learning disability? Perhaps vision or hearing problems make it difficult for your child to concentrate in school? Maybe your child is being bullied? All of these can be terribly distracting for a young child and can contribute to poor behavior. School problems may warrant an evaluation by the child’s school for learning disabilities and a hearing and vision screening by your pediatrician.
Want to really impress your doctor? Fill out the “Vanderbilt” ADHD assessment tool. There is a parent form and a teacher form. Your doctor will score the sheet. This very simple tool can help determine whether your child has ADHD or something else.
Are you concerned about your child’s behavior? Has anyone told you that your child should be evaluated for ADHD? Please share your experiences.
Mario Cruz is is an assistant professor of pediatrics at Drexel University College of Medicine and an academic pediatrician at St. Christopher's Hospital for Children.

Posted by Mario Cruz, M.D. @ 6:53 AM 

http://www.philly.com/philly/health/Think-your-child-has-ADHD-Think-again-.html?cmpid=138896554

Read more: http://www.philly.com/philly/health/Think-your-child-has-ADHD-Think-again-.html?cmpid=138896554#ixzz1rG6nyNBK

Snoring and Sleep apnea, is it so inflammatory?

From Dr. Susarla....

Snoring and Sleep apnea, is it so inflammatory?

A recent article in the journal Chest summarizes the association of breathing problems during sleep with multiple other medical conditions in children, raising concerns about how dangerous snoring may be.

Excerpted below: Among the many articles on childhood sleep-disordered breathing (SDB) in the last several years, there is a recurring theme: an array of comorbidities. Whether the disorder is defined as habitual snoring, upper airway resistance syndrome, or obstructive sleep apnea (OSA), studies have consistently linked SDB in children with seemingly unrelated symptoms of neuropsychologic deficits, obesity, cardiovascular abnormalities, parasomnias, and inflammation.

In addition, there appears to be a genetic association for childhood SDB. In the current issue of CHEST (see page 519), Li and colleagues1 have performed a large-scale population survey of symptom clusters and have demonstrated that all of these comorbid symptoms of SDB are increased in a population of children with habitual snoring. Their study in > 6,000 children aged 5 to 14 years with habitual snoring suggests an association of SDB with genetic influences, BMI, neuropsychologic problems, and inflammation, including recent upper-respiratory infection, allergic rhinitis, tonsillitis, and sinusitis. Do these clinical features relate to a single mechanism?

Chest September 2010 138:469-471
http://chestjournal.chestpubs.org/content/138/3/469.full

Pesticide Exposure in the Womb Increases ADHD Risk

Exposure to pesticides while in the womb may increase the odds that a child will have attention deficit hyperactivity disorder, according to researchers at the University of California-Berkeley School of Public Health. Combine that with research published in May in Pediatrics finding that children exposed to pesticides were more likely to have ADHD, and it's enough to make parents wonder how to reduce their family's exposure to pesticides.

http://health.usnews.com/health-news/blogs/on-parenting/2010/08/20/pesticide-exposure-in-the-womb-increases-adhd-risk.html