Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 218-225 (doi:10.1542/peds.2008-2525)
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ARTICLE

Sleep-Disordered Breathing and Behaviors of Inner-City Children With Asthma

Maria Fagnano, MPHa, Edwin van Wijngaarden, PhDb, Heidi V. Connolly, MDc, Margaret A. Carno, PhDc, Emma Forbes-Jones, PhDd and Jill S. Halterman, MD, MPHa

a Department of Pediatrics
b Community and Preventive Medicine
c School of Nursing
d Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York

OBJECTIVE: To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma.

METHODS: We examined data for 194 children (aged 4–10 years) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed by using the Sleep-Related Breathing Disorder Questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the Sleep-Related Breathing Disorder Questionnaire by removing the 6 attention/hyperactivity items. A sleep score of >0.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI), which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores.

RESULTS: The majority of children (mean age: 8.2 years) were male (56%), black (66%), and insured by Medicaid (73%). Overall, 33% of the children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared with children without SDB on total BPI (13.7 vs 8.8) and the subdomains externalizing (9.4 vs 6.3), internalizing (4.4 vs 2.5), anxious/depressed (2.4 vs 1.3), headstrong (3.2 vs 2.1), antisocial (2.3 vs 1.7), hyperactive (3.0 vs 1.8), peer conflict (0.74 vs 0.43), and immature (2.0 vs 1.5). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI scores and externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SDB subscales (snoring, sleepiness).

CONCLUSIONS: We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from additional intervention.

Key Words: childhood asthma • inner-city • behavior • sleep-disordered breathing

Abbreviations: BPI—Behavior Problem Index • OSA—obstructive sleep apnea • SDB—sleep-disordered breathing • SRBD—sleep-related breathing disorder

Accepted Nov 7, 2008.


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