Symptoms of Sleep-Disordered Breathing in 5-Year-Old Children Are Associated With Sleepiness and Problem Behaviors
* Department of Medicine
Psychiatry
Pediatrics
|| Neurology, Boston University School of Medicine, Boston, Massachusetts
¶ Slone Epidemiology Center, Boston University School of Medicine, Boston, Massachusetts
# Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
** Department of Pediatrics, Rush University, Chicago, Illinois
Objective. Sleep-disordered breathing (SDB) in children is reportedly associated with problem behaviors suggestive of attention-deficit/hyperactivity disorder; however, there are few data on the relation of SDB to problem behaviors in the general pediatric population. The goal of this study was to assess the prevalence of SDB symptoms in 5-year-old children and their relation to sleepiness and problem behaviors.
Methods. A population-based, cross-sectional survey was conducted of a birth cohort of children who were born in eastern Massachusetts. Subjects were 3019 5-year-old children (1551 boys, 1468 girls) who were enrolled in the Infant Care Practices Study and whose mothers were contacted within 3 months of their child’s fifth birthday. A parent-completed questionnaire was used to ascertain the presence and intensity of snoring and other SDB symptoms and the presence of daytime sleepiness and problem behaviors. Parent-reported hyperactivity, inattention, and aggressiveness were each assessed by a single question that was validated against the Conners’ Parent Rating Scale. SDB was defined as frequent or loud snoring; trouble breathing or loud, noisy breathing during sleep; or witnessed sleep apnea.
Results. Parent-reported hyperactivity (19%) and inattention (18%) were common, with aggressiveness (12%) and daytime sleepiness (10%) reported somewhat less often. SDB symptoms were present in 744 (25%) children. Compared with children without snoring or other symptoms of SDB, children with SDB symptoms were significantly more likely to have parent-reported daytime sleepiness (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.7–2.8) and problem behaviors, including hyperactivity (OR: 2.5; CI: 2.0–3.0), inattention (OR: 2.1; 95% CI: 1.7–2.6), and aggressiveness (OR: 2.1; 95% CI: 1.6–2.6). These associations remained significant after adjustment for sex, race/ethnicity, maternal education level, maternal marital status, household income, and respiratory health history.
Conclusions. SDB symptoms are common in 5-year-old children and are associated with an increased risk of daytime sleepiness and with problem behaviors suggestive of attention-deficit/hyperactivity disorder.
Key Words: snoring • sleep-disordered breathing • sleep apnea • behavior • hyperactivity
Abbreviations: SDB, sleep-disordered breathing • OSA, obstructive sleep apnea • ICPS, Infant Care Practices Study • FYFQ, Five-Year Follow-up Questionnaire • CPRS, Conners’ Parent Rating Scale • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • OR, odds ratio • HI, Hyperactivity Index • PSQ, Pediatric Sleep Questionnaire
Received for publication Sep 16, 2002; Accepted Feb 21, 2003.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Fagnano, E. van Wijngaarden, H. V. Connolly, M. A. Carno, E. Forbes-Jones, and J. S. Halterman Sleep-Disordered Breathing and Behaviors of Inner-City Children With Asthma Pediatrics, July 1, 2009; 124(1): 218 - 225. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K A Bonuck, K Freeman, and J Henderson Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis Arch. Dis. Child., February 1, 2009; 94(2): 83 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 C. E. Kuehni, M-P. F. Strippoli, E. S. Chauliac, and M. Silverman Snoring in preschool children: prevalence, severity and risk factors Eur. Respir. J., February 1, 2008; 31(2): 326 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
H. E. Montgomery-Downs, L. M. O'Brien, T. E. Gulliver, and D. Gozal Polysomnographic Characteristics in Normal Preschool and Early School-Aged Children Pediatrics, March 1, 2006; 117(3): 741 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. E. Montgomery-Downs and D. Gozal Snore-Associated Sleep Fragmentation in Infancy: Mental Development Effects and Contribution of Secondhand Cigarette Smoke Exposure Pediatrics, March 1, 2006; 117(3): e496 - e502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 R. J. Thomas, B. R. Rosen, C. E. Stern, J. W. Weiss, and K. K. Kwong Functional imaging of working memory in obstructive sleep-disordered breathing J Appl Physiol, June 1, 2005; 98(6): 2226 - 2234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. K. Larkin, C. L. Rosen, H. L. Kirchner, A. Storfer-Isser, J. L. Emancipator, N. L. Johnson, A. M. V. Zambito, R. P. Tracy, N. S. Jenny, and S. Redline Variation of C-Reactive Protein Levels in Adolescents: Association With Sleep-Disordered Breathing and Sleep Duration Circulation, April 19, 2005; 111(15): 1978 - 1984. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
H. E. Montgomery-Downs, V. M. Crabtree, and D. Gozal Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea Eur. Respir. J., February 1, 2005; 25(2): 336 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Lester Allergic Rhinitis in Children with ADHD AAP Grand Rounds, February 1, 2005; 13(2): 20 - 21. [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
eLetters:
Read all eLetters
- Problem behaviors - sleep disordered breathing linkage needs further study
- William N. Marshall
- Pediatrics Online, 3 Dec 2003 [Full text]
