Behavioral outcomes in children with sleep disordered breathing: impact of weight, sleep duration, and co-morbid sleep disorders
ABSTRACT To assess the relative contribution of potential risk factors for adverse neurobehavioral outcomes in children referred for evaluation of sleep-disordered breathing (SDB), including weight, mean sleep duration, and comorbid sleep disorders.
Medical record review.
Academic pediatric medical center.
Clinical sample of 235 children aged 3 to 18 years undergoing overnight polysomnography for symptoms of SDB.
History of behavioral, emotional, and academic problems and Child Behavior Checklist (CBCL) scores.
More than half (56%) of the sample was overweight or at risk for overweight, more than one-third (36%) was classified as being short sleepers, and almost half (49%) had at least 1 additional sleep diagnosis. Forty-seven percent had a history of behavioral problems and 23% had a reported diagnosis of attention-deficit/hyperactivity disorder. There were no significant differences in CBCL scores based on any measure of SDB disease severity. Increased weight was associated with increased internalizing CBCL scores in a dose-dependent fashion (P = .003), while short sleepers were more likely to have elevated externalizing scores (P < .001). Overall, the strongest predictor of adverse behavioral outcomes was the presence of at least 1 additional sleep diagnosis (P < .001).
The relationship between SDB and parent-reported behavioral outcomes in children is complex. In addition to SDB-related impairments, clinicians should consider the relative contributions of being overweight, insufficient sleep, and comorbid sleep disorders when assessing behavior in these children.
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- "Five others lacked a control group and were excluded [14,32e35]. Another five were excluded for the following reasons: one study selected only for children who had both OSA and ADHD in the clinical group , one study did not specify the relationship between AHI and ADHD symptoms , one had PSG done but did not present AHI results , and two used excessive daytime sleepiness rather than SDB; this latter symptom can originate from a variety of causes other than SDB and was thus excluded  . In yet another study, the authors used an unvalidated , two-item ADHD scale to compare the two groups; thus, this study was excluded . "
ABSTRACT: Background A relationship between attention deficit hyperactivity disorder (ADHD) and sleep disordered breathing (SDB) in children and adolescents has been suggested by some authors. Yet, this topic remains highly controversial in the literature. Objectives To examine the extent of relationship between SDB and ADHD symptoms in pediatric populations. To examine whether there are differences in ADHD symptoms pre- versus post-adenotonsillectomy in pediatric populations. Methods PubMed/Medline, PsychInfo and Cochrane data bases were searched using the key words “attention deficit hyperactivity disorder” or “ADHD” and “obstructive sleep apnea” or “OSA” or “sleep disordered breathing” (SDB) or “SDB”. English language publications through September 2012 were surveyed. Meta-analysis was conducted to assess the relationship between SDB and ADHD symptoms in the first part of the study, and the extent of change in ADHD symptoms before and after adenotonsillectomy in the second part. Results Eighteen studies satisfied the inclusion criteria for the first part of the study. This represented 1,113 children in the clinical group (874 diagnosed with SDB who were examined for ADHD symptoms; 239 diagnosed with ADHD who were examined for SDB) and 1,405 in the control-group. Findings indicate that there is a medium relationship between ADHD symptoms and SDB (Hedges’ g = 0.57, 95% confidence interval: 0.36-0.78; p = 0.000001). A high apnea hypopnea index (AHI) cutoff was associated with lower effect sizes, while child age, gender and body mass index did not moderate the relationship between SDB and ADHD. Study quality was associated with larger effect sizes. In the second part of the study, twelve studies were identified assessing pre- versus post-surgery ADHD symptoms. Hedges’ g was 0.43 (95% confidence interval = 0.30-0.55; p < 0.001; N = 529) suggesting a medium effect, as adenotonsillectomy was associated with decreased ADHD symptoms at 2-13 months post-surgery. Conclusion Our findings suggest that ADHD symptoms are related to SDB and improve after adenotonsillectomy. Therefore, patients with ADHD symptomatology should receive SDB screening. Treatment of comorbid SDB should be considered before medicating the ADHD symptoms if present.Sleep Medicine Reviews 12/2013; 18(4). DOI:10.1016/j.smrv.2013.12.003 · 9.14 Impact Factor
- Archivos de Bronconeumología 01/2011; 47:2–18. DOI:10.1016/S0300-2896(11)70026-6 · 1.82 Impact Factor
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ABSTRACT: To examine how many hours preschool children in the United States sleep at night and to test the hypothesis that children with shorter nighttime sleep duration are more likely to exhibit externalizing behaviors. The Early Childhood Longitudinal Study-Birth Cohort is a nationally representative longitudinal cohort study that followed children born in 2001 through kindergarten. This cross-sectional study examines the preschool wave (n = ∼8950). We estimated nighttime sleep duration from parent's reports of their 4-year-old child's typical weekday bed and wake times. Parents rated their child on 6 different externalizing behaviors (overactivity, anger, aggression, impulsivity, tantrums, and annoying behaviors) on a scale from 1 through 5 using the Preschool and Kindergarten Behavior Scale-second edition. Multivariable regression analyses were used to examine the association between sleep duration and behavior scores and to control for possible confounders. Results are weighted to total United States population, ∼3,895,100 children born in 2001. Mean sleep duration was 10.47 hours. Mean bedtime was 8:39 PM and wake time was 7:13 AM. The adjusted odds ratios for children sleeping <9.44 hours (1 standard deviation below the mean) versus those sleeping ≥9.44 hours for 6 different externalizing behavior outcomes were as follows: overactivity = 1.30 (95% confidence interval [CI], 1.03-1.65); anger = 1.40 (95% CI, 1.15-1.71); aggression = 1.81 (95% CI, 1.36-2.41); impulsivity = 1.44 (95% CI, 1.12-1.86); tantrums = 1.46 (95% CI, 1.16-1.85); and annoying behaviors = 1.40 (95% CI, 0.97-1.87). Shorter nighttime sleep duration in preschool children is associated with higher likelihood of externalizing behavioral symptoms based on parental report.Journal of developmental and behavioral pediatrics: JDBP 01/2010; 34(6):384-91. DOI:10.1097/DBP.0b013e31829a7a0d · 2.12 Impact Factor