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Ζητήματα συμπεριφοράς παιδιών συνδέονται με διαταραχές στην αναπνοή

Αμερικανική μελέτη στην οποία συμμετείχαν περισσότερα από 10.000 παιδιά έδειξε ότι τα μικρά παιδιά που ροχαλίζουν πολύ ή έχουν κάποια άλλη αναπνευστική δυσκολία τις νύχτες ενδέχεται να διατρέχουν αυξημένο κίνδυνο να εμφανίσουν συμπεριφορικά ή συναισθηματικά προβλήματα αργότερα στη ζωή τους.

Η έρευνα, η οποία δημοσιεύτηκε στην επιθεώρηση Pediatrics, δεν είναι η πρώτη που συνδέει ζητήματα συμπεριφοράς με διαταραχές στην αναπνοή στη διάρκεια του ύπνου με τα παιδιά είτε να ροχαλίζουν, είτε να αναπνέουν από το στόμα ή να πάσχουν από υπνική άπνοια.

«Δεν επινοήσαμε τον συσχετισμό» είπε η επικεφαλής ερευνήτρια Κάρεν Μπόνακ στο Κολλέγιο Ιατρικής Άινσταϊν της Νέας Υόρκης.

Αλλά η έρευνα της ομάδας της, η οποία παρακολούθησε περισσότερα από 13.000 παιδιά από τη νηπιακή ηλικία ως τα επτά τους χρόνια, είναι η μεγαλύτερη που έχει γίνει για αυτό το πρόβλημα.

Από τα παιδιά αυτά, το 45% παραμένει χωρίς προβλήματα αναπνοής τη νύχτα, σύμφωνα με τους γονείς τους. Τα υπόλοιπα εμφάνισαν συμπτώματα κάποια στιγμή στη διάρκεια της νηπιακής ηλικίας ή τα πρώτα χρόνια της παιδικής.

Το 8% των παιδιών εμπίπτει στην «χειρότερη» κατά τους ερευνητές κατηγορία με προβλήματα αναπνοής που κορυφώθηκαν στην ηλικία των δύο και των τριών και επέμειναν.

Συνολικά, η ομάδα της Μπόνακ διαπίστωσε ότι τα παιδιά με προβλήματα αναπνοής στον ύπνο ήταν πιθανότερο να εμφανίσουν μέχρι τα επτά τους χρόνια διαταραχές της συμπεριφοράς ή συναισθηματικές, όπως Σύνδρομο Ελλειμματικής Προσοχής και Υπερκινητικότητας (ADHD) ή άγχος.

Σχεδόν το 13,5% είχαν τέτοια συμπτώματα στα επτά τους, σε αντίθεση με λίγο πάνω από το 8% των παιδιών που είχαν απαλλαγεί από προβλήματα αναπνοής στον ύπνο.

Stress is a fact of life, even for children. Childhood is full of typical stressors, including developmental stressors such as puberty and situational stressors such as moving and going to a new school. However, for some children, stress is more than a developmental norm; it is a full-blown anxiety disorder that disrupts their lives. Children with anxiety disorders are usually so afraid, worried, or uneasy that they become unable to function normally. Nurse practitioners (NPs) must be able to differentiate normal childhood anxiety from anxiety disorder so that affected children can receive proper and early intervention.

Anxiety disorders are the most common psychiatric conditions found in adolescents, and most adult anxiety disorders begin in childhood, adolescence, and early adulthood. Recent estimates suggest that 8%-22% of children and adolescents may suffer from an anxiety disorder.[1] In 13- to 18-year-olds, the prevalence of anxiety disorder is 25.1% and is 5.9% for severe anxiety disorder.

Although very common, anxiety disorders in children are often overlooked or misjudged. Because a certain level of anxiety is normal, it becomes important to distinguish between normal and pathological levels of anxiety. The experience of anxiety often has 2 components: physical (such as headache, stomachache, and sweating) and emotional (nervousness and fear). Anxiety disorders, however, often affect children’s thinking, decision-making ability, and perceptions of the environment. They can raise children’s blood pressure and cause a number of physical ailments, including diarrhea, shortness of breath, and palpitations, and are frequently accompanied by other disorders, such as depression and substance abuse.

Anxiety Disorders: A Review

Anxiety disorders commonly seen during childhood include the following:

General anxiety disorder (GAD): GAD is defined as excessive worry, anxiety, and apprehension occurring on most days, for a period of 6 months or more. The worries are diffuse, pertaining to a number of topics and events. Children with GAD have difficulty controlling their anxiety, which can be associated with feeling “on the edge” or pent up; restlessness; becoming easily fatigued; trouble concentrating or a feeling that one’s “mind goes blank”; irritability; muscle tension; and sleep disturbances. This anxiety causes serious distress or problems functioning.
Adjustment disorder with anxiety: This disorder occurs within 3 months of a specific stressor, such as a move, change of school, or parental divorce. The child experiences feelings of anxiety, nervousness, and worry that cause marked distress in excess of what would be expected from the situation, and that can seriously impair the child’s social or academic performance. The anxiety usually dissipates within 6 months after the initiating stressor ceases.

Separation anxiety disorder: These children experience intense anxiety, sometimes to the point of panic, when separated from a parent or other loved one. Separation anxiety typically appears suddenly in children who had no previous signs of anxiety. The anxiety is so severe that such children cannot perform daily activities. When separated, they become preoccupied with morbid fears of harm that will come to them or fears that their parents will not return. Separation anxiety can give way to school phobia, whereby the children will refuse to go to school because they fear separation from their parents.

Obsessive-compulsive disorder (OCD): Once thought to occur only in adults, this disorder is now more frequently diagnosed in children. OCD is characterized by persistent obsessions (intrusive, unwanted thoughts, images, or urges) and compulsions (intensive, uncontrollable, and repetitive behaviors or mental acts related to the obsessions). These obsessions and compulsions cause distress and consume a huge amount of the child’s time. The most common obsessions involve dirt and contamination, repeated doubts, and the need to have things a specific way. Others include fearful aggressive or murderous impulses and disturbing sexual images. Frequent compulsions include repetitive handwashing, using tissues or gloved hands to touch things, touching and counting things, checking locks, counting rituals, repeating actions, and requesting reassurance. Children with OCD become trapped in the cycle of repetitive thoughts and actions. Even though they realize that their thoughts and behaviors appear senseless and distressing, they cannot stop them from occurring.

Specific phobia: This is an excessive, persistent fear that is recognized as unreasonable and is triggered by a specific object or thought, such as snakes, spiders, computers, close spaces, heights, flying, and getting injured. Exposure to the object or event provokes immediate anxiety. The distress is so severe that it interferes with the child’s functioning or routines.

Social phobia: A very common phobia, social phobia is the persistent and substantial fear of one or more social situations in which children are exposed to unfamiliar people or scrutiny by others. During these situations, the child is afraid that he or she will behave in a manner that will be embarrassing or humiliating. Exposure to these situations causes significant anxiety and possible panic, despite knowing that the fear is unreasonable. This fear can cause the child to avoid such situations, leading to marked interference in life.

Panic disorder: Recurrent panic attacks are sudden, discrete episodes of intense fear that are usually accompanied by a desire to escape and a feeling of doom or impending danger. These usually peak in 10 minutes, subside in 20-30 minutes, and are accompanied by at least 4 of the following: palpitations, sweating, shortness of breath or feeling smothered, trembling or shaking, sweating, nausea and abdominal pain, dizziness, lightheadedness, feeling faint, sense of unreality or being detached from one’s self, fear of losing control or going crazy, numbness and tingling, and chills or hot flashes.

Acute stress disorder (ASD) or posttraumatic stress disorder (PTSD): In both of these disorders, children have been exposed to a traumatic event during which they experienced, witnessed, or were confronted by a situation (eg, abuse, violence, natural or manmade disaster) that involved an actual or perceived threat of serious injury or death. The response involves intense fear, helplessness, or horror, and the child relives the event in recurrent images, thoughts, or dreams. The child may also believe that the event is recurring or feel intense anxiety in situations that resemble the event. Children with ASD or PTSD can also experience some of the following: inability to remember details of the event, diminished interest in activities, feelings of detachment, restricted emotional range, difficulty making decisions, irritability, agitation, anger, resentment, numbness, spontaneous crying, and a sense of despair. ASD occurs within days of the event and lasts less than 1 month, whereas PTSD has a delayed onset and lasts more than a month.