Habitual snoring, intermittent hypoxia, and impaired behavior in primary school children.
OBJECTIVE
Sleep-disordered breathing is associated with impaired behavior and poor academic performance in children. We aimed to determine the extent of behavioral problems in snoring children, clarify the role of intermittent hypoxia, and test the reversibility of impaired behavior and poor academic performance.


METHODS
In 1144 children, habitual snoring (HS; snoring frequently or always) and impaired behavior were assessed using parental questionnaires. Intermittent hypoxia (ie, presence of > or =5 arterial oxygen desaturations by > or =4% or > or =1 desaturation to < or =90%) was investigated with pulse oximetry. Poor academic performance (grade 4-6 on a 6-point scale in mathematics, science, or spelling) was based on the last school report. HS, impaired behavior, and academic performance were reevaluated after 1 year. Adjusted odds ratios (ORs) were calculated using unconditional logistic regression.


RESULTS
HS was significantly associated with hyperactive (OR: 2.4) and inattentive behavior (OR: 4.0), daytime tiredness (OR: 7.1), and sleepiness (OR: 2.6-4.8). These associations were independent of intermittent hypoxia. HS was also significantly associated with bad conduct (OR: 2.8), emotional symptoms (OR: 5.5), and peer problems (OR: 9.7). At follow-up, hyperactive and inattentive behavior but not academic success had significantly improved in children in whom HS had ceased.


CONCLUSIONS
We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.
Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
Michael S
MS
Urschitz
Steffen
S
Eitner
Anke
A
Guenther
Esther
E
Eggebrecht
Judith
J
Wolff
Pilar M
PM
Urschitz-Duprat
Martin
M
Schlaud
Christian F
CF
Poets
D000342:Affective Symptoms / Q000209:etiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology*; D006970:Disorders of Excessive Somnolence / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D007859:Learning Disabilities / Q000209:etiology; D016015:Logistic Models; D008297:Male; D012913:Snoring / Q000150:complications*; D011795:Surveys and Questionnaires