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PEDIATRICS Vol. 109 No. 3 March 2002, pp. 449-456

Inattention, Hyperactivity, and Symptoms of Sleep-Disordered Breathing

Ronald D. Chervin, MD, MS*, Kristen Hedger Archbold, PhD*, James E. Dillon, MD{ddagger}, Parviz Panahi, MD§, Kenneth J. Pituch, MD§, Ronald E. Dahl, MD|| and Christian Guilleminault, MD

* Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan
{ddagger} Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
§ Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
|| Child and Adolescent Sleep Laboratory, Departments of Psychiatry and Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Sleep Disorders Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California

--> Objective. Inattention and hyperactivity are frequent among children with sleep-disordered breathing (SDB) and often improve when SDB is treated. However, the frequency of SDB symptoms among inattentive and hyperactive children has received little study.

Design. Cross-sectional survey.

Setting. Two university-affiliated but community-based general pediatrics clinics.

Patients. Patients consisted of N = 866 children (469 boys), aged 2.0 to 13.9 years (mean: 6.8 ± 3.2 years), with clinic appointments.

Measures. A validated Pediatric Sleep Questionnaire assessed for habitual snoring (1 item), snoring severity (a 4-item subscale), sleepiness (4 items), and overall risk of SDB (16 items). Parents also completed 2 common behavioral measures, an inattention/hyperactivity scale (IHS) derived from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the hyperactivity index (HI, expressed as a t score) of the Conners’ Parent Rating Scale.

Results. Habitual snoring was reported in 16% (95% confidence interval [CI]: 13, 19) of the participants. High HI scores (>60) were found in 13% (95% CI: 11, 16) of all participants, 22% (95% CI: 15, 29) of habitual snorers, and 12% (95% CI: 9, 14) of nonsnorers. Odds ratios between HI >60 and each of the following were: habitual snoring, 2.2 (95% CI: 1.4, 3.6); 1 additional positive symptom-item on the snoring scale, 1.3 (95% CI: 1.1, 1.5); 1 additional positive item on the sleepiness scale, 1.6 (95% CI: 1.4, 2.0); and a 1-standard deviation increase in the overall SDB score, 1.7 (95% CI: 1.4, 2.0; all odds ratios age- and sex-adjusted). Results were similar for high IHS scores (>1.25). Stratification by age and sex showed that most of the association with snoring (but not sleepiness) derived from boys <8 years old.

Conclusions. Inattention and hyperactivity among general pediatric patients are associated with increased daytime sleepiness and—especially in young boys—snoring and other symptoms of SDB. If sleepiness and SDB do influence daytime behavior, the current results suggest a major public health impact.

Key Words: child • sleep • sleep disorders • snoring • sleep apnea • obstructive • disorders of excessive somnolence • Pediatric Sleep Questionnaire • attention • hyperactivity • attention deficit disorder with hyperactivity • child behavior disorders • neuropsychological tests

Abbreviations: ADHD, attention-deficit/hyperactivity disorder • SDB, sleep-disordered breathing • PSQ, Pediatric Sleep Questionnaire • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • IHS, inattention/hyperactivity scale • HI, hyperactivity index • CI, confidence interval

Received for publication May 29, 2001; Accepted Aug 8, 2001.




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