Sleep disorders may go unrecognized in high performing children. Poor school performance is often a warning sign to teachers, administrators and parents of an underlying behavioral or sleep disorder. However, the warning signs of poor sleep can be ignored if a child is performing well academically. The symptoms of sleep apnea (OSA) can be easy to miss in children. While adults with OSA tend to complain of daytime fatigue, children may become hyperactive or irritable. This often leads to a misdiagnosis of attention deficit or hyperactivity disorder.

Previous research shows that treatment of sleep apnea can lead to behavioral improvements in children who are struggling in the classroom or at home. However, a study published last week in the International Journal of Pediatric Otorhinolaryngology shows it’s just as important to pay attention to how high achievers are sleeping. Specifically, parents should be aware of snoring or labored breathing. Regular snoring or difficulty breathing is considered a strong indicator of sleep apnea. In this study, the children suspected of having sleep apnea were treated with adenotonsillectomy (surgery to remove the adenoids and tonsils). Following surgery, parents graded their child’s behavior in areas such as inattention, hyperactivity and social problems. The results demonstrated that sleep patterns, snoring and behavior improved for all children in the study, including those with higher intellectual ability. This study demonstrates that we should not only be focused on a child’s intellectual ability, but also their social and behavioral growth. Furthermore, poor sleep can impair a child’s social and behavioral development. According to study co-author, Bruno Giordani, “Once behavior improves, attention in school improves, and emotional ability and behavioral and impulsivity control improve.”

Frequently, parents with children who snore come to our office for help. They will tell us that their children perform well at school and question if they should pursue treatment. I think the aforementioned study confirms what we, as sleep specialists, witness on a daily basis. If you improve a child’s sleep quality, this can have widespread positive implications on all aspects of their lives. Perhaps we should consider evaluating a child’s sleep as part of their yearly school physical. We listen to a child’s heart and lungs and check their weight. Maybe we should also inquire about their sleep.

If you are a parent and your child snores, they should be evaluated by your physician. Prompt diagnosis and treatment can influence a child’s physical, mental, emotional and social development. Not every child requires surgery, but an exam should be performed to decide a treatment plan.


“Improved behavior after adenotonsillectomy in children with higher and lower IQ,” International Journal of Pediatric Otorhinolaryngology, Jan. 8.

Alan S. Berger, M.D.
Donald M. Sesso,M.D.