Some Crucial Facts about the Negative Impact of

                                Sleep Disorders on Students' Performance & Health

I am hoping that you will please consider some of the important facts below and help us find a way to present this information to parents and pediatric professionals through the national media:

1.  Approximately one in three students will develop a sleep problem or disorder some time during their school years (Mindell & Owens, 2003).

2.  Approximately 15-17% of our students will have a significant sleep disorder that impacts learning, behaviors, health, and/or safety (This is over 15 million students!). These students usually need some type of medical treatment or behavioral interventions to correct their sleep problems/disorders (Ax, 2006; National Institute of Health, 2001, etc...). Ignoring the sleep problem will not make it go away, and these sleep disorders often become more severe and impairing with age!

3.  Only 2% of all students with sleep disorders are identified by their primary care physicians and referred to sleep specialists for treatment. The rest remain unidentified until later in adulthood or are never identified, resulting in a poorer quality of life than controls without sleep problems/disorders (Rosen et al., 2001).

4.  The impact of unidentified sleep problems/disorders is often manifested as poor emotional/behavioral regulation in the forms of hyperactivity or distractibility, irritability, oppositional behaviors, aggression, depressive tendencies, and/or poor impulse control (Chervin et al., 1997; Chervin et al., 2002; Chervin & Guilleminault, 1996; Dahl, 1994; Luginbuehl, 2004, Picchieti et al., 1998; 1999; etc....).

5.  A meta-analysis of 17 research studies published between 1977 and 2001 found that students with Obstructive Sleep Apnea Syndrome (OSAS) or milder forms of  Sleep-Disordered Breathing (SDB) had significantly more problems than controls in the areas of cognition, academic performance, behavior problems, and daytime sleepiness.  Researchers also reported significant improvements in those areas post-treatment (Ebert & Drake, 2004). Further studies supported these findings and suggested that OSAS can impair cognitive functioning if not identified and corrected early (El-Ad, Engleman & Joffe, 1999; Lavie, 2005; Ferini-Strambi, Baietto, Gioia et al, 2003; Ridderinkhof et al, 2004; Rosen et al, 2005). Time is of essence with correction of OSAS!

6.  Gradual, but significant improvement in school performance or GPA has been noted by parents and teachers when some sleep disorders are corrected early in students' school careers (Gozal, 1998; Guilleminault et al., 1982; Luginbuehl, 2004, etc...).

7.  Approximately 30-33% of these students with unidentified and untreated sleep problems/disorders are evaluated by a team of school professionals and placed in special education programs due to the many school problems that develop (French, 2008; Luginbuehl, 2004; Popkave, 2007; Witte, 2007). , and approx. 25% are diagnosed with psychiatric disorders and placed on medications for behavioral or emotional regulation (Luginbuehl, 2004).

8.  African-American children, adolescents, and young adults have a 2-3 times higher prevalence rate of Obstructive Sleep Apnea Syndrome (OSAS) than Caucasians (Redline et al., 1997; Rosen, 1999).  This might be one of the main reasons for the over-identification of African-American students into special education programs. Early screening/correction would lower the number of A-A students in special education, as well as lower their high school drop-out rates and other problems resulting from dropping out.

9.  Many health problems ensue when sleep disorders like OSAS are not identified and treated.  Children's blood pressure and heart rates increase significantly during sleep apnea events at night (Bixler et al, 2008; Constantin, McGregor, Cote, & Brouillette, 2008).

10.  Children develop Endothelial Disfunction (ED) (the beginning symptoms of cardiovascular disease) when their OSAS goes untreated, but ED disappears after the OSAS is corrected or treated early (Gozal, et al., 2007). 

11.  MRI's of 41 adults with severe OSAS compared to 69 controls showed significant damage to the Limbic, Pre-Frontal, & Hippocampus areas of the Brain of severe OSAS vs. Controls. This damage was caused by lack of oxygen to the brain, small blood vessel disease, etc.. (Macey, P.M. et al., 2008). 

12.  In children, these apnea events negatively affect the Brain's functioning in many ways:
  - Memory deficits caused by damage to the hippocampus      (Numerous studies)
  - Spatial Learning deficits      
  - Overall Cognition (IQ) is lower    (Ridderinkhof et al, 2004; Engleman & Joffe, 1999)
  - Planning Ability is poor   
  - Mood Regulation is poor due to damage to the Frontal Lobe and Limbic area of brain         (Drevets et al, 1997; King et al, 1999; etc.)
  - More Hyperactivity & Depression (Beebe et al,2004; Chervin et al., 1997; Chervin et al., 2002; etc.)

13.  If Severe OSA is corrected too late, the brain usually does not recover & cognitive deficiencies remain (El-Ad, Lavie, 2005; Ferini-Strambi, Baietto, Gioia et al, 2003; Rosen et al, 2005). 

14.  Severe SDB / OSAS adults have 3.0 times more deaths than controls when followed in a long-term study (p<.008) due to "All Causes of Death": They have more car wrecks, strokes, heart attacks, cancer, suicide, diabetes, etc. than controls (Young et al, 2008).

Time is of the Essence with our children who have OSAS!

15.  Children and adolescents in the USA are getting 1-2 hours less sleep per night than they need to perform at their highest levels in school due to poor sleep habits, late night use of video games, cell phones, television, caffeine drinks, etc...(Wolfson & Carskadon, 1999).

16.  Numerous studies between 2001 and 2010 have found that children whose sleep was restricted by only one hour required increased cognitive effort to complete work, had poorer attention span & ability to learn, decreased academic output, poorer memory, & slower processing speed; they also exhibited more impulsivity, aggression, irritability, & acting-out behaviors.
17.  Meta-analysis of children < 10 yrs reported a 9% decrease in body fat and obesity with a One (1) Hour increase in sleep (Chen, X., Beydoun, M.A., & Wang, Y., 2008).

18.  The rate of Delayed Sleep Phase Syndrome (DSPS) in adolescents has risen from approx. 7% in 1988 (Thorpy et al., 1988) to 10.7% in 2006 (Johnson, et al, 2006) due to the many electronic distracters that interfere with teens' sleep until late into the night. 

19.  Students with DSPS have lower GPAs, more absences and tardies, a higher drop-out rate in high school, and a lower graduation rate than peers without DSPS (Thorpy et al., 1988; Wolfson & Carskadon, 2003, etc...).

20.  Roane, Daniel & Taylor (2008) followed 3,582 adolescents for 6-7 years and reported that 9.4% struggled with long-term insomnia or DSPS. The DSPS group used alcohol, canabis, and other illegal substances 1.5 times more than peers without DSPS, 53% with insomnia suffered from depression, and the DSPS group had 3.5 times more suicide attempts than peers without DSPS.

21.  Unidentified Periodic Limb Movement Disorder (PLMD) may be the cause of at least 25% of the ADHD symptoms in students (Chervin et al., 2003; Konofal et al., 2004; Lewin & Pinto, 2004; Luginbuehl, 2004; Picchieti et al., 1998; 1999) and can be treated with medication before bedtime (Walters et al., 2003, etc...) or sometimes iron therapy supplements in cases where there is a serum ferritin deficit (Beard, 2004; Early et al., 2000; Guyatt et al., 1992;  Konofal et al., 2004; Kryger et al., 2002).  The daytime ADHD symptoms usually improve significantly when the PLMD is treated.

22.  There are approx. 200,000 vehicular accidents annually in the USA caused by Excessive Daytime Sleepiness, and 50% of these sleep-related accidents are drivers between 16 – 25 yrs. (Carskadon et al., 2004; Wolfson & Carskadon, 2003). This statistic alone results in thousands of deaths and injuries annually, costing billions of dollars for vehicular damage and health costs, not to mention the trauma and suffering to many accident victims and their families.

23.  The six major pediatric sleep disorders impairing students' school performance are Obstructive Sleep Apnea Syndrome (OSAS), Narcolepsy, Periodic Limb Movement Disorder (PLMD), Restless Legs Syndrome (RLS), Delayed Sleep Phase Syndrome (DSPS), and Behavioral Insomnia of Childhood (BIC) (Luginbuehl, 2004; Luginbuehl & Bradley-Klug, 2008).  Most of these sleep disorders, except maybe narcolepsy, are usually corrected easily, usually with improvements to children's learning, behaviors, health, or safety if identified and treated early.

There is a window of opportunity for early screening and treatment, which can result in excellent improvements in these children's education and health!

Although we have only mentioned some of the many crucial educational and health facts regarding pediatric sleep disorders, we hope it will be evident that this information needs to be broadcast to parents throughout the USA because millions of children and adolescents are suffering unnecessarily at this time and often receiving misdiagnoses, unnecessary pharmacological treatment, or special education placements that might not be necessary if their sleep disorders were corrected early.  However, it is very disheartening that there are so many roadblocks by professionals and institutions that are preventing this information from being spread quickly to the masses of parents whose children's educational progress is being limited, self-esteem destroyed, and health compromised or even lives lost. It is time to Wake Up America!