Sleep-disordered Breathing Scores Research Articles

The frequency of sleep-disordered breathing in preschool children with asthma and its effects on control of asthma.

The frequency and score of SDB were higher in patients with uncontrolled asthma. Frequency and score of SDB were significantly affected by the severity of asthma. SDB must be evaluated in preschool children with uncontrolled asthma. Sleep-disordered breathing (SDB) is more common in asthmatic patients than in non-asthmatic persons, and SDB affects negatively to control asthma. A limited number of studies are discovered on the effect of SDB in preschool asthmatic children. In this study, we aimed to investigate the prevalence of SDB and its effect on control and severity of asthma in preschool children. A pediatric sleep questionnaire was completed by parents of asthmatic children. Patients who received a score of 0.33 or higher were diagnosed with SDB. Control and severity of asthma was assessed by a pediatric allergy specialist based on the Global Initiative for Asthma (GINA) criteria. The study included 249 patients, with a mean±SD age of 4.37±1.04 (range: 2-5.9) years; 69% were boys; 56.6% children had uncontrolled asthma and 28.7% had SDB. The SDB score was significantly different between controlled and uncontrolled asthma (0.19 vs 0.28; P < 0.001). The frequency of uncontrolled asthma in patients with and without SDB was 74.3% and 49.4%, respectively (P < 0.010). Based on the severity of asthma, the frequency of SDB among patients with mild, moderate, and severe asthma was 23.4%, 35.2%, and 47.4%, respectively (P = 0.010).

0990 Evaluating Components Of Sleep Quality And The Sleep-Quality Of Life Relationship For Children With Acute Lymphoblastic Leukemia

Abstract Introduction Poor sleep quality is associated with reduced health-related quality of life (HRQL) for children with Acute Lymphoblastic Leukemia (ALL). Research has yet to evaluate how components of child sleep quality uniquely contribute to HRQL beyond demographic characteristics. This study evaluates features of sleep and the relationship between sleep and HRQL for children in the maintenance phase of ALL treatment. Methods 89 caregivers (ages 20-52, M=35.95, SD=7.10) of children with ALL (ages 3-12, M=5.73, SD=2.21; 13.76 months from diagnosis) completed demographic questionnaires and reports of child sleep quality (Child Sleep Habits Questionnaire; CSHQ), and 64 caregivers reported on child HRQL (Pediatric Quality of Life Inventory). Descriptive statistics were calculated. T-tests compared CSHQ subscales to ratings of healthy normative values. Pearson correlations evaluated associations between sleep and overall HRQL. Hierarchical regression assessed whether CSHQ subscales uniquely predicted HRQL beyond demographic characteristics. Results This sample reported greater bedtime resistance [t(88)=6.413, p&amp;lt;.001], sleep onset delay [t(88)=3.180, p=.002], sleep anxiety [t(88)=4.271, p&amp;lt;.001], night awakenings [t(88)=6.031, p&amp;lt;.001], parasomnias [t(88)=3.900, p&amp;lt;.001], and daytime sleepiness [t(87)=1.781, p=.078] than normative values, although sleep duration [t(88)=1.781, p=.078] and sleep disordered breathing (SDB) [t(88)=-.061, p=.951] did not differ. HRQL was related to SDB (r=-.289, p=.021), bedtime resistance (r=-.263, p=.036), and total sleep score (r=-.34, p=.006). The regression model with SDB and bedtime resistance explained 24.2% of variance but was not significant [F(6,31)=1.651, p=.167]. Conclusion Caregiver ratings showed greater sleep impairments for children in this sample than of norms. Sleep subscales were associated with HRQL, but did not predict HRQL beyond demographic factors. Caregiver reports of child sleep and HRQL may vary depending on when during the monthly chemotherapy cycle questionnaires were completed. SDB did not differ from normative values but was related to HRQL, suggesting the need to screen for SDB symptoms to potentially improve child outcomes. Support This study was supported by funding from the American Cancer Society PF-13-238-01-PCSM (PI: Daniel).

Coblation® intracapsular tonsillectomy in children with recurrent tonsillitis: Initial experience

ObjectivesThe use of Coblation® intracapsular tonsillectomy for the treatment of sleep disordered breathing (SDB)/obstructive sleep apnoea (OSA) has an increasing evidence base. However, the results for tonsillitis as the predominant indication for surgery are not as clear. We present our initial results from 80 paediatric cases undergoing Coblation® intracapsular tonsillectomy for infective indications. MethodsProspective case series within the secondary care environment, January 2016–July 2018, all with completed follow-up. We utilised the validated T14 tonsil symptom questionnaire pre- and postoperatively and also collected data regarding postoperative complications. Results80 consecutive patients (age range 2–16 years and mean 7.2 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy) predominantly for infective reasons although some also had concomitant adenoidectomy for snoring/sleep disordered breathing were included.Mean follow-up was at 13 months postoperatively. 38 children had tonsillitis (with or without snoring) and 42 children had SDB in combination with tonsillitis. The mean over-all total T14 score was 32.7 preoperatively and 2.7 postoperatively (p < 0.0001). The mean infective score was 22.1 preoperatively and 1.5 postoperatively (p < 0.0001). The mean SDB score was 10.6 preoperatively and 1.5 postoperatively (p < 0.0001). There were no cases of haemorrhage, re-admission or regrowth noted. ConclusionCoblation® intracapsular tonsillectomy is a safe and effective technique for treating children with recurrent tonsillitis. Future studies should incorporate longer term follow-up.

Sleep-disordered breathing and neurobehavioral symptoms in children in a Southeast Nigerian city

Introduction: Sleep-related breathing difficulties can lead to neurobehavioral symptoms in children. They can be assessed through validated screening questionnaires. Objective: This study aims to determine the prevalence of sleep-disordered breathing (SDB) among children, as well as neurobehavioral symptoms and associated risk factors. Materials and Methods: Descriptive cross-sectional study was conducted using the pediatric sleep questionnaire to assess sleep habits such as snoring and sleep apnea; neurobehavioral symptoms such as easy distractibility and disruptive behavior. The sample size of the study was 400 participants consecutively enrolled from consenting households in the enumeration areas in Enugu, Southeast Nigeria. Percentage prevalence of neurobehavioral symptoms was calculated, and SDB scores assigned with the determining cutoff score of &gt;0.33. Analyses for an association of SDB score with socio-economic class (SEC), age, and gender, were performed using relevant statistics. Results: Of the 338 children aged between 2 and 18 years, 47% (158) were males. Children between 2 and 5 years represented 30% (101), while 59% (110) and 11% (46) were children 5–10 years and &gt;10 years, respectively. The mean age of all participants was 6.4±3.1 years, 10% (34) belonged to SEC one while 49% (164) and 41% (139) belonged to middle and lower classes, respectively. At least one of SDB symptoms was present in 73% (248) of participants, but the SDB criteria score was met by 45 participants giving a prevalence of 13.3%. The most prevalent neurobehavioral symptoms were bed wetting in 56.8% (192), easy distractibility in 50.9% (167), and excessive day time sleepiness in 41.3% (139) cases. SDB was more likely in children with up to seven neurobehavioral symptoms, with an odds ratio of 8.27 (CI 3.48–19.66). Conclusions: SDB prevalence rate was found to be high in the present estimated pediatric population. The presence of seven or more neurobehavioral symptoms was associated with SDB and was predominant in children aged between 5 and 10 years.

Impact of adenotonsillectomy on urinary storage symptoms in children with sleep-disordered breathing

ObjectiveTo prospectively evaluate the effectiveness of adenotonsillectomy on resolving urinary storage symptoms such as frequency, urgency, and urgency urinary incontinence (UUI) in indicated sleep disordered breathing (SDB) patients. MethodsWe prospectively analyzed changes in storage symptoms and SDB score before and after surgery in 102 children (74 males, 28 females, mean age 8.4 ± 2.8 years) who underwent adenotonsillectomy between July 2011 and Feb 2012. Before and 3 months after surgery, all children and their parents were requested to answer a self-reported SDB scale-questionnaire (22 questions, 0–22 points) and a urinary storage symptoms questionnaire. ResultsThe prevalence of urgency in the overall patients was 31.2%. After adenotonsillectomy, prevalence of frequency and, urgency in addition to SDB score were significantly decreased (p ≦ 0.001). The prevalence of UUI was also significantly lower (11.6%–7.4%, p < 0.001). Patients with urgency had a significantly higher SDB score than those without (11.4 ± 4.3 vs. 7.8 ± 4.0, p < 0.001). After treatment, there was no difference between these two groups. ConclusionAdenotonsillectomy markedly improved both SDB score and decreased the prevalence of voiding symptoms (frequency, urgency, and UUI). There was a strong correlation between preoperative SDB score and severity of urgency in children with SDB.

Behavioral consequences of children with sleep-disordered breathing after adenotonsillectomy.

Adenotonsillectomy (AT) has been an effective treatment for sleep-disordered breathing (SDB) in children, and several studies described the risk of postoperative weight gain and obesity in children treated with AT. The present study aimed to evaluate behavioral improvements in children with SDB oneyear after adenotonsillectomy and to investigate an influence of postoperative weight gain on behaviors. The study included 170 children aged 5-11years who underwent adenotonsillectomy for SDB and 150 controls. Body mass index percentile was obtained for age and gender, and parental sleep-related breathing disorder (SRBD) questionnaire was used to assess the severity of SDB. Psychological assessment was performed pre- and post-adenotonsillectomy using standardized questionnaires including strength and difficulties questionnaire, children's depression inventory and screen for child anxiety-related emotional disorder. The mean age of 170 patients was 7.7±1.5years with 73 (42.9%) girls and 97 (57.1%) boys. The mean follow-up period were 15.4±2.7months. The patients had shown significant improvements in SDB scores as well as in questionnaire-based behavioral problems after adenotonsillectomy. The odds of a child being overweight were significantly increased after adenotonsillectomy. Less improvements in hyperactivity and conduct problems were observed in the patients with older ages, higher SRBD scores, and overweight/obesity at 1-year follow-up after adenotonsillectomy. These data suggest that abnormal behavioral outcomes should be evaluated postoperatively, which potentially could be reduced with the early adenotonsillectomy and adequate postoperative weight control.

Symptoms of Sleep Disordered Breathing in Children with Craniofacial Malformations

The purpose of this study was to investigate the frequency of sleep disordered breathing (SDB) symptoms in a clinical sample of children with congenital craniofacial malformations (CFM) followed at a tertiary medical center and non-selected for sleep problems. Cross-sectional study of 575 children aged 2-18 years followed at the Craniofacial Anomalies Program between March 2007 and May 2011. The Sleep-Related Breathing Disturbance scale of the Pediatric Sleep Questionnaire was used to screen for SDB, snoring, and sleepiness. A cutoff value ≥ 0.33 of the total answered questions identified children with positive screening for SDB symptoms. Overall, 25% of children screened positive for SDB, 28% for snoring, and 20% for sleepiness. In children with non-syndromic CFM, those with Robin sequence had the highest frequency of SDB, snoring, and sleepiness (43%, 44%, and 38%, respectively). In children with syndromic CFM, velocardiofacial/ DiGeorge syndrome had the highest frequency of SDB and sleepiness (48% and 43%, respectively). Children with Treacher Collins had the highest frequency of snoring (83%). The presence of cleft palate was not associated with an increased frequency of SDB symptoms. Nevertheless, children with syndromic CFM, compared to those with non-syndromic CFM, had a higher SDB score (0.27 ± 0.21 vs.0.21 ± 0.19, p = 0.003) and were more likely to have sleepiness (26% vs. 18%, p = 0.05). Congenital craniofacial malformations in children are associated with high risk for SDB symptoms. Our findings should encourage a high index of suspicion for SDB in children with CFM, with a low threshold for further testing and close follow-up. Moraleda-Cibrián M; Edwards SP; Kasten SJ; Berger M; Buchman SR; O'Brien LM. Symptoms of sleep disordered breathing in children with craniofacial malformations.

Markers of Sleep Disordered Breathing and Diabetes Mellitus in a Multiethnic Sample of US Adults: Results from the National Health and Nutrition Examination Survey (2005–2008)

We examined gender and ethnic differences in the association between sleep disordered breathing (SDB) and diabetes among 6,522 participants aged ≥20 years from the National Health and Nutrition Examination Survey 2005–08. SDB severity was defined based on an additive summary score including sleep duration, snoring, snorting, and daytime sleepiness. We found that the summary SDB score was significantly associated with diabetes after adjusting for potential confounders in the whole population. Compared to those without any sleep disturbance, the multivariable odds ratio (OR) (95% confidence interval (CI)) of diabetes among those with ≥3 sleep disturbances was 2.04 (1.46–2.87). In sex-specific analyses, this association was significant only in women (OR (95% CI) = 3.68 (2.01–6.72)) but not in men (1.10 (0.59–2.04)), P-interaction = 0.01. However, there were no ethnic differences in this association, P-interaction = 0.7. In a nationally representative sample of US adults, SDB was independently associated with diabetes only in women, but not in men.

Elevated Serum C-Reactive Protein and Markers of Sleep Disordered Breathing

Background. Previous studies indicated sleep-disordered breathing (SDB) is associated with cardiovascular disease (CVD). Systemic inflammation is recognized as a risk factor for CVD. Studies examining SDB and inflammation are limited. Methods. We studied sleep duration, snoring, snorting, and daytime sleepiness, and an additive SDB score. The main outcome was a C-reactive protein (CRP) of >1 mg/dL. Results. Snoring, snorting, daytime sleepiness, and sleeping >7 or <7 hours, and the additive score were significantly associated with high CRP. The additive score was not associated in men but moderately associated in women in a multivariable model adjusting for age, gender, race/ethnicity, education, smoking, hypertension, alcohol intake, physical activity, body mass index, depression, diabetes, hypertension, and total cholesterol (P-interaction = 0.42). For race/ethnicity, the association was strongest in Mexican Americans/others, modest in Non-Hispanic whites, and absent in Non-Hispanic blacks (P-interaction = 0.07). Conclusions. The association between SDB and high CRP was present mainly in women and Mexican Americans, implying SDB has a residual, independent association with inflammation after controlling for lifestyle and metabolic risk factors like BMI, physical activity, depression, diabetes, and cholesterol.

Markers of Sleep-Disordered Breathing and Metabolic Syndrome in a Multiethnic Sample of US Adults: Results from the National Health and Nutrition Examination Survey 2005–2008

Previous studies have documented an association between markers of sleep-disordered breathing (SDB) and metabolic syndrome. However, it is not clear if there are gender or ethnic differences in this association. We examined 6,122 participants aged ≥20 years from the National Health and Nutrition Examination Survey 2005–08. Metabolic syndrome was defined as the presence of ≥3 of the following components: (1) abdominal obesity, (2) elevated blood triglycerides, (3) low HDL cholesterol, (4) high BP, and (5) hyperglycemia. SDB severity was defined based on an additive summary score including sleep duration, snoring, snorting, and daytime sleepiness. We found that short sleep duration, snoring, snorting, daytime sleepiness and the summary SDB score were significantly associated with metabolic syndrome independent of potential confounders. Compared to those without any sleep disturbance, the multivariable odds ratio (OR) (95% confidence interval [CI]) of metabolic syndrome among those with three or more sleep disturbances was 3.92 (2.98–5.16). In subgroup analyses, this association was consistently present among men and women and all race-ethnic groups. In summary, SDB was independently associated with metabolic syndrome in a nationally representative sample of US adults.

The prevalence of sleepiness and the risk of sleep‐disordered breathing in children with positive allergy test

We evaluated the prevalence of sleep-disordered breathing (SDB) and sleepiness in children with allergy and compared sleep-specific quality of life measures to those of children without allergy. A prospective case-control study was done at a tertiary care academic center. The parents of 21 pediatric patients with positive environmental allergy testing completed questionnaires including the Obstructive Sleep Apnea-18 (OSA18), the Pediatric Sleep Questionnaire (PSQ), and the Pediatric Daytime Sleepiness Scale (PDSS). Comparisons were made to 113 children without allergy who had undergone cochlear implantation (CI) who served as controls. SDB was suggested in 19% of children with allergy using the OSA18 and in 29% using the PSQ vs 6% and 7% of controls (p = 0.029; p = 0.003), respectively. In addition, daytime sleepiness was suggested in 45% to 48% of children with allergy using the PSQ and PDSS vs 17% to 25% of controls (p = 0.015; p = 0.025), respectively. Patients with allergy had SDB and sleepiness scores higher than population normal values: OSA-18 of 41.7 vs 34.0, PSQ-SDB of 0.25 vs 0.14, PSQ-Sleepy of 0.34 vs 0.15, and PDSS of 14.2 vs 11.4. The difference between cases and controls was significant for all measures of sleepiness and SDB. Children with allergy have higher SDB and sleepiness scores than controls. This suggests that children with allergic rhinitis are at increased risk for SDB and screening should be considered in this population. In addition, studies with a larger sample size are important to fully understand this relationship.

Sleep-disordered breathing symptoms frequency and growth among prematurely born infants

Background Children who were born prematurely are at higher risk for sleep-disordered breathing (SDB) compared to their same-age peers who were born fullterm. Objective The objective of the present study was to assess the frequency of SDB symptoms and effects on growth among preterm infants while they are still infants, with a goal of identifying risk factors to facilitate prevention and early intervention. Methods The Louisville pediatric SDB risk survey was administered to the primary caretakers of prematurely born infants attending the Neonatal Follow-Up Clinic at West Virginia University Children’s Hospital. Results Participation was 100% among 173 consecutive patients invited to participate in the study. At 9.13 months corrected age, 8.1% of infants born at a mean of 31.6 weeks gestation were reported to snore ⩾3 days/week, a rate consistent with diagnosis of sleep-disordered breathing among older children. A composite of nine parent-reported symptoms was created based on factor analysis. Birth weight and size for gestational age at birth did not differ between snoring groups or correlate with the composite score. But a significant negative correlation between the composite risk for SDB score and current weight for adjusted age percentile score indicate that infants with higher SDB symptom profiles have lower weight for age ( r = −.18, p = .028). Conclusions SDB symptoms are detectable among infants born preterm, while they are still infants. Because of their preferential risk for SDB and its somatic consequences, a primary research goal should be description of the natural history of SDB and identification of modifiable risk factors and treatment options.

The insulin gene variable number of tandem repeats (INS VNTR) genotype and sleep disordered breathing in childhood obesity

Aim of our study is to verify the association between the genetic predisposition to hyperinsulinism due to the presence of the insulin gene (INS) I/I genotype and the development of sleep-related breathing disorders (SRBD) in obese children and adolescents. Two hundred and fifty-six obese children and adolescents (125 girls) have been investigated. As initial screening all subjects' mothers filled out the Sleep Disturbances Scale for Children (SDSC). The Sleep-Disordered Breathing (SDB) scale has been taken into account. Successively, a subgroup of 34 patients belonging to the first (14 children) and the last (20 children) SDB score quintiles underwent an overnight polysomnography and the apnea-hypopnea index (AHI) was evaluated. All subjects were genotyped for the INS VNTR and fasting insulin levels were evaluated. The population was divided into two groups according to the genotype: the first group was comprehensive of patients homozygotes for class I allele and the second group was composed by class III allele heterozygotes and homozygotes patients. Subjects I/I showed statistically signifIcant higher insulin levels (p<0.001) and SDB scores (p<0.001). Moreover, in the subgroup of patients investigated with polysomnography, class I homozygous subjects showed higher AHI compared to those patients carrying class III allele (p<0.001). Our data support the hypothesis that INS VNTR is associated with the development of SDB among obese children and adolescents.

Nocturnal enuresis and sleep disordered breathing in children

Purpose There is a well recognised association between sleep disordered breathing (SDB) (formerly known as obstructive sleep apnoea) and nocturia in adults. It would be fair to hypothesise that nocturia could present as nocturnal enuresis (NE) in children, thus raising the question whether SDB (a common problem in children) could play a role in the aetiology of NE. A literature search revealed little research into the association between NE and SDB and the results were contradictory and inconclusive. The aim of this study was to explore this area further to determine whether there is an association between these two common conditions. Material and methods The Study Group comprised 40 patients, aged 5-15yrs, attending the enuretic clinic and the Control Group a further 40 patients, matched for age and sex, undergoing routine day case surgery not involving the urinary tract or ENT. Subjects completed the validated Chervin SDB and an enuretic questionnaire. Statistical analysis used Pearson's Chi2, Fishers exact test and Mann Whitney U tests where appropriate. Results Both groups were well matched for age and sex. Patients with NE had significantly higher positive Chervin Sleep Disordered Breathing Score than controls (p Conclusions Patients with nocturnal enuresis, irrespective of the type, onset, severity, age or sex had significantly higher positive CSDBS than controls. Therefore there is a clear association between NE and SDB in children. This finding opens up further investigative pathways and treatment modalities for those patients with NE who do not respond to standard treatment.

Waist circumference predicts the occurrence of sleep-disordered breathing in obese children and adolescents: A questionnaire-based study

Background and purpose To assess the presence of sleep-disordered breathing (SDB) in a population of obese children and adolescents and to investigate the role of fat distribution in predicting SDB. Patients and methods One hundred and thirty-two obese children and adolescents, aged 5.0–14.2 years, were consecutively referred to the Department of Pediatrics of the Second University of Naples for screening of obesity. The control group consisted of 453, sex- and age-matched lean subjects selected from local schools in Campania region. The sleep disturbances scale for children (SDSC) questionnaire was used to evaluate SDB prevalence. In all subjects, waist circumference, triceps and sub-scapular skin folds were measured, and Z-scores were calculated. Results Obese subjects showed significantly higher SDB and sleep hyperhydrosis (SHY) scores than controls. The Z-score of waist circumference correlated with SDB ( r=0.32; P=0.006) and SHY factor scores ( r=0.37; P=0.005), while the Z-score of body mass index (BMI), triceps and sub-scapular skin folds were not correlated with any SDSC factor scores. Subjects in the higher tertile for Z-score of waist circumference had a significantly higher risk for developing SDB (OR 1.9; 95% IC 1.8–3.2) and SHY (OR 2.1; 95% IC 2.0–4.5). Conclusions Waist circumference is a more reliable index than total adiposity and subcutaneous fat in predicting the risk of obese children to develop SDB.

The German study on sleep‐disordered breathing in primary school children: epidemiological approach, representativeness of study sample, and preliminary screening results

In order to study the prevalence of habitual snoring (HS), obstructive sleep apnoea (OSA), other aspects of sleep-disordered breathing (SDB), and their determinants, we enrolled a cross-section of children from the population of third graders attending regular primary schools in Hannover, Germany. The recruitment strategy followed a multistage, probability-clustered design. Selected schools were compared with eligible schools regarding the percentage of children with low socio-economic status (SES). The recruitment process was analysed and response proportions calculated. Study subjects were compared with their school enrolment cohort based on anonymous data provided by school authorities. Habitual snoring and OSA were investigated using parental questionnaires and all children underwent nocturnal home pulse oximetry. There was a good overall representativeness of sampled schools with regard to the percentage of children with low SES. In total, 1760 children were contacted and 1144 (65.0%) agreed to participate. The whole process of self-selection of study subjects was not differential by gender. Compared with their school enrolment cohort, study subjects had slightly higher educated parents. The prevalence of HS was estimated to be 10.1% [95% CI 8.3, 11.9%]; and 3.2% [2.2, 4.2%] and 3.9% [2.8, 4.2%] had an abnormally high OSA or SDB score respectively. Based on pulse oximetry, 2.4% [95% CI 1.5, 3.4%] had 3 D(90)and 3 D(C), 1.0% [0.4, 1.6%] had the DI(90) > 0.6, and 3.3% [2.2, 4.4%] had the DI(4) > 3.9 and the DI(C) > 0.4. This study sample appears to be highly representative with regard to all available data from the population, and therefore suitable to study the prevalence of HS and OSA. Our prevalence estimates are in the range of other studies.

Conduct Problems and Symptoms of Sleep Disorders in Children

Conduct problems and hyperactivity are frequent among children referred for sleep-disordered breathing (SDB), restless legs syndrome, or periodic leg movements during sleep (PLMS), but children not referred to sleep centers have received little study. Parents of children aged 2 to 14 years were surveyed at two general clinics between 1998 and 2000. A Pediatric Sleep Questionnaire generated validated scores for SDB and PLMS. The Conners Parent Rating Scale (CPRS-48) produced an age- and sex-adjusted Conduct Problem Index (CPI) and Hyperactivity Index. Parents of about 1,400 children were approached; those of 872 (62%) completed the surveys. Bullying and other specific aggressive behaviors were generally two to three times more frequent among 114 children at high risk for SDB than among the remaining children. An association between high CPI and SDB scores (p <.0001) retained significance after adjustment for sleepiness, high Hyperactivity Index, stimulant use, or PLMS scores. Analogous results were obtained for the association between high CPI and PLMS scores. Conduct problems were associated with symptoms of SDB, restless legs syndrome, and PLMS. Although these results cannot prove a cause-and-effect relationship, assessment for sleep disorders may provide a new treatment opportunity for some aggressive children.

Inattention, Hyperactivity, and Symptoms of Sleep-Disordered Breathing

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. Cross-sectional survey. Two university-affiliated but community-based general pediatrics clinics. Patients consisted of N = 866 children (469 boys), aged 2.0 to 13.9 years (mean: 6.8 plus minus 3.2 years), with clinic appointments. 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. 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. 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.