This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chervin, R. D.
Right arrow Articles by Guilleminault, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chervin, R. D.
Right arrow Articles by Guilleminault, C.
Related Collections
Right arrow Neurology & Psychiatry
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

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.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 J Atten DisordHome page
Shenghui Li, Xinming Jin, Chonghuai Yan, Shenghu Wu, Fan Jiang, and Xiaoming Shen
Sleep Problems in Chinese School-Aged Children with a Parent-Reported History of ADHD
J Atten Disord, July 1, 2009; 13(1): 18 - 26.
[Abstract] [PDF]

Home page
 Journal of the American Dental AssociationHome page
H. B. Waldman, F. M. Hasan, and S. Perlman
Down Syndrome and Sleep-Disordered Breathing: The Dentist's Role
J Am Dent Assoc, March 1, 2009; 140(3): 307 - 312.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
N. Nakra, S. Bhargava, J. Dzuira, S. Caprio, and A. Bazzy-Asaad
Sleep-Disordered Breathing in Children With Metabolic Syndrome: The Role of Leptin and Sympathetic Nervous System Activity and the Effect of Continuous Positive Airway Pressure
Pediatrics, September 1, 2008; 122(3): e634 - e642.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
J. A. Owens, R. Mehlenbeck, J. Lee, and M. M. King
Effect of Weight, Sleep Duration, and Comorbid Sleep Disorders on Behavioral Outcomes in Children With Sleep-Disordered Breathing
Arch Pediatr Adolesc Med, April 1, 2008; 162(4): 313 - 321.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
A. Hvolby, J. Jorgensen, and N. Bilenberg
Actigraphic and Parental Reports of Sleep Difficulties in Children With Attention-Deficit/Hyperactivity Disorder
Arch Pediatr Adolesc Med, April 1, 2008; 162(4): 323 - 329.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
V. Sung, H. Hiscock, E. Sciberras, and D. Efron
Sleep Problems in Children With Attention-Deficit/Hyperactivity Disorder: Prevalence and the Effect on the Child and Family
Arch Pediatr Adolesc Med, April 1, 2008; 162(4): 336 - 342.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
O. S. Capdevila, L. Kheirandish-Gozal, E. Dayyat, and D. Gozal
Pediatric Obstructive Sleep Apnea: Complications, Management, and Long-term Outcomes
Proceedings of the ATS, February 15, 2008; 5(2): 274 - 282.
[Abstract] [Full Text] [PDF]

Home page
 Arch Otolaryngol Head Neck SurgHome page
J. L. Wei, M. S. Mayo, H. J. Smith, M. Reese, and R. A. Weatherly
Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-Disordered Breathing
Arch Otolaryngol Head Neck Surg, October 1, 2007; 133(10): 974 - 979.
[Abstract] [Full Text] [PDF]

Home page
 FASEB J.Home page
S. G. Vincent, A. E. Waddell, M. G. Caron, J. K. L. Walker, and J. T. Fisher
A murine model of hyperdopaminergic state displays altered respiratory control
FASEB J, May 1, 2007; 21(7): 1463 - 1471.
[Abstract] [Full Text] [PDF]

Home page
 Arch Otolaryngol Head Neck SurgHome page
R. D. Chervin, R. A. Weatherly, S. L. Garetz, D. L. Ruzicka, B. J. Giordani, E. K. Hodges, J. E. Dillon, and K. E. Guire
Pediatric Sleep Questionnaire: Prediction of Sleep Apnea and Outcomes
Arch Otolaryngol Head Neck Surg, March 1, 2007; 133(3): 216 - 222.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
A. Tarasiuk, S. Greenberg-Dotan, T. Simon-Tuval, B. Freidman, A. D. Goldbart, A. Tal, and H. Reuveni
Elevated Morbidity and Health Care Use in Children with Obstructive Sleep Apnea Syndrome
Am. J. Respir. Crit. Care Med., January 1, 2007; 175(1): 55 - 61.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
P. M. Suratt, M. Peruggia, L. D'Andrea, R. Diamond, J. T. Barth, M. Nikova, V. A. Perriello Jr, and M. L. Johnson
Cognitive Function and Behavior of Children With Adenotonsillar Hypertrophy Suspected of Having Obstructive Sleep-Disordered Breathing
Pediatrics, September 1, 2006; 118(3): e771 - e781.
[Abstract] [Full Text] [PDF]

Home page
 J Am Psychiatr Nurses AssocHome page
K. H. Archbold
Sleep Disorders and Attention-Deficit Hyperactivity Disorder in Children: A Missing Differential Diagnosis
Journal of the American Psychiatric Nurses Association, August 1, 2006; 12(4): 216 - 224.
[Abstract] [PDF]

Home page
 Biol Res NursHome page
L. C. Johnson, T. L. Richards, K. H. Archbold, and C. A. Landis
Functional magnetic resonance imaging in nursing research.
Biol Res Nurs, July 1, 2006; 8(1): 43 - 54.
[Abstract] [PDF]

Home page
 J Pediatr PsycholHome page
J. G. Noll, P. K. Trickett, E. J. Susman, and F. W. Putnam
Sleep Disturbances and Childhood Sexual Abuse
J. Pediatr. Psychol., June 1, 2006; 31(5): 469 - 480.
[Abstract] [Full Text] [PDF]

Home page
 Arch Otolaryngol Head Neck SurgHome page
S. R. Shott, R. Amin, B. Chini, C. Heubi, S. Hotze, and R. Akers
Obstructive sleep apnea: Should all children with Down syndrome be tested?
Arch Otolaryngol Head Neck Surg, April 1, 2006; 132(4): 432 - 436.
[Abstract] [Full Text] [PDF]

Home page
 J Pediatr PsycholHome page
S. A. Mulvaney, J. L. Goodwin, W. J. Morgan, G. R. Rosen, S. F. Quan, and K. L. Kaemingk
Behavior Problems Associated with Sleep Disordered Breathing in School-Aged Children--the Tucson Children's Assessment of Sleep Apnea Study
J. Pediatr. Psychol., April 1, 2006; 31(3): 322 - 330.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. D. Chervin, D. L. Ruzicka, B. J. Giordani, R. A. Weatherly, J. E. Dillon, E. K. Hodges, C. L. Marcus, and K. E. Guire
Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy
Pediatrics, April 1, 2006; 117(4): e769 - e778.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
J. C. Goll and C. M. Shapiro
Sleep disorders presenting as common pediatric problems
Can. Med. Assoc. J., February 28, 2006; 174(5): 617 - 619.
[Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
J. L. Emancipator, A. Storfer-Isser, H. G. Taylor, C. L. Rosen, H. L. Kirchner, N. L. Johnson, A. M. Zambito, and S. Redline
Variation of Cognition and Achievement With Sleep-Disordered Breathing in Full-term and Preterm Children
Arch Pediatr Adolesc Med, February 1, 2006; 160(2): 203 - 210.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. N. Roemmich, J. E. Barkley, L. D'Andrea, M. Nikova, A. D. Rogol, M. A. Carskadon, and P. M. Suratt
Increases in Overweight After Adenotonsillectomy in Overweight Children With Obstructive Sleep-Disordered Breathing Are Associated With Decreases in Motor Activity and Hyperactivity
Pediatrics, February 1, 2006; 117(2): e200 - e208.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
D. K. Ng, K.-l. Kwok, J. M. Cheung, S.-y. Leung, P.-y. Chow, W. H. Wong, C.-h. Chan, and J. C. Ho
Prevalence of Sleep Problems in Hong Kong Primary School Children: A Community-Based Telephone Survey
Chest, September 1, 2005; 128(3): 1315 - 1323.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
C. Guilleminault, J. H. Lee, and A. Chan
Pediatric Obstructive Sleep Apnea Syndrome
Arch Pediatr Adolesc Med, August 1, 2005; 159(8): 775 - 785.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
G M Nixon and R T Brouillette
Sleep {middle dot} 8: Paediatric obstructive sleep apnoea
Thorax, June 1, 2005; 60(6): 511 - 516.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
C. M. Rembold and P. M. Suratt
An upper airway resonator model of high-frequency inspiratory sounds in children with sleep-disordered breathing
J Appl Physiol, May 1, 2005; 98(5): 1855 - 1861.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
K. B. van der Heijden, M. G. Smits, and W. B. Gunning
Sleep-related Disorders in ADHD: A Review
Clinical Pediatrics, April 1, 2005; 44(3): 201 - 210.
[PDF]

Home page
 AAP Grand RoundsHome page
M. R. Lester
Allergic Rhinitis in Children with ADHD
AAP Grand Rounds, February 1, 2005; 13(2): 20 - 21.
[Full Text] [PDF]

Home page
 PediatricsHome page
C. L. Rosen, A. Storfer-Isser, H. G. Taylor, H. L. Kirchner, J. L. Emancipator, and S. Redline
Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing
Pediatrics, December 1, 2004; 114(6): 1640 - 1648.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. S. Urschitz, S. Eitner, A. Guenther, E. Eggebrecht, J. Wolff, P. M. Urschitz-Duprat, M. Schlaud, and C. F. Poets
Habitual Snoring, Intermittent Hypoxia, and Impaired Behavior in Primary School Children
Pediatrics, October 1, 2004; 114(4): 1041 - 1048.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
C. S. Melendres, J. M. Lutz, E. D. Rubin, and C. L. Marcus
Daytime Sleepiness and Hyperactivity in Children With Suspected Sleep-Disordered Breathing
Pediatrics, September 1, 2004; 114(3): 768 - 775.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. L. Bass, M. Corwin, D. Gozal, C. Moore, H. Nishida, S. Parker, A. Schonwald, R. E. Wilker, S. Stehle, and T. B. Kinane
The Effect of Chronic or Intermittent Hypoxia on Cognition in Childhood: A Review of the Evidence
Pediatrics, September 1, 2004; 114(3): 805 - 816.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
L. M. O'Brien, C. B. Mervis, C. R. Holbrook, J. L. Bruner, C. J. Klaus, J. Rutherford, T. J. Raffield, and D. Gozal
Neurobehavioral Implications of Habitual Snoring in Children
Pediatrics, July 1, 2004; 114(1): 44 - 49.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
C. L. Marcus
Pediatric Sleep Medicine Comes Into Its Own
Pediatrics, May 1, 2004; 113(5): 1393 - 1394.
[Full Text] [PDF]

Home page
 PediatricsHome page
L. Palombini, R. Pelayo, and C. Guilleminault
Efficacy of Automated Continuous Positive Airway Pressure in Children With Sleep-Related Breathing Disorders in an Attended Setting
Pediatrics, May 1, 2004; 113(5): e412 - e417.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
G. M. Nixon, A. S. Kermack, G. M. Davis, J. J. Manoukian, K. A. Brown, and R. T. Brouillette
Planning Adenotonsillectomy in Children With Obstructive Sleep Apnea: The Role of Overnight Oximetry
Pediatrics, January 1, 2004; 113(1): e19 - 25.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
V. M. Crabtree, A. Ivanenko, and D. Gozal
Clinical and Parental Assessment of Sleep in Children with Attention-Deficit/Hyperactivity Disorder Referred to a Pediatric Sleep Medicine Center
Clinical Pediatrics, November 1, 2003; 42(9): 807 - 813.
[Abstract] [PDF]

Home page
 ChestHome page
C. Shin, S. Joo, J. Kim, and T. Kim
Prevalence and Correlates of Habitual Snoring in High School Students
Chest, November 1, 2003; 124(5): 1709 - 1715.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
D. J. Gottlieb, R. M. Vezina, C. Chase, S. M. Lesko, T. C. Heeren, D. E. Weese-Mayer, S. H. Auerbach, and M. J. Corwin
Symptoms of Sleep-Disordered Breathing in 5-Year-Old Children Are Associated With Sleepiness and Problem Behaviors
Pediatrics, October 1, 2003; 112(4): 870 - 877.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. S. Urschitz, A. Guenther, E. Eggebrecht, J. Wolff, P. M. Urschitz-Duprat, M. Schlaud, and C. F. Poets
Snoring, Intermittent Hypoxia and Academic Performance in Primary School Children
Am. J. Respir. Crit. Care Med., August 15, 2003; 168(4): 464 - 468.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
J. L. Goodwin, S. I. Babar, K. L. Kaemingk, G. M. Rosen, W. J. Morgan, D. L. Sherrill, and S. F. Quan
Symptoms Related to Sleep-Disordered Breathing in White and Hispanic Children: The Tucson Children's Assessment of Sleep Apnea Study
Chest, July 1, 2003; 124(1): 196 - 203.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
L. M. O'Brien, C. R. Holbrook, C. B. Mervis, C. J. Klaus, J. L. Bruner, T. J. Raffield, J. Rutherford, R. C. Mehl, M. Wang, A. Tuell, et al.
Sleep and Neurobehavioral Characteristics of 5- to 7-Year-Old Children With Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder
Pediatrics, March 1, 2003; 111(3): 554 - 563.
[Abstract] [Full Text] [PDF]

Home page
 J Child NeurolHome page
Y. Leitner, A. M. Bloch, A. Sadeh, O. Neuderfer, L. Tikotzky, A. Fattal-Valevski, and S. Harel
Sleep-Wake Patterns in Children With Intrauterine Growth Retardation
J Child Neurol, December 1, 2002; 17(12): 872 - 876.
[Abstract] [PDF]

Home page
 J Child NeurolHome page
Y. Leitner, A. Mimouni Bloch, A. Sadeh, O. Neuderfer, L. Tikotzky, and S. Harel
Sleep-Wake Patterns in Children With Intrauterine Growth Retardation
J Child Neurol, December 1, 2002; 17(12): 872 - 876.
[Abstract] [PDF]

Home page
 PediatricsHome page
E. Mick and R. D. Chervin
Attention-Deficit/Hyperactivity Disorder and Sleep
Pediatrics, October 1, 2002; 110(4): 850 - 852.
[Full Text] [PDF]

Home page
 JWatch PediatricsHome page
Symptoms of Sleep-Disordered Breathing and ADHD Are Linked
Journal Watch Pediatrics and Adolescent Medicine, June 28, 2002; 2002(628): 4 - 4.
[Full Text]

Home page
 JWatch GeneralHome page
Snoring and Hyperactivity in Children
Journal Watch (General), April 2, 2002; 2002(402): 4 - 4.
[Full Text]