title: Increased behavioral morbidity in school-aged children with sleep-disordered breathing.
abstract: OBJECTIVE
  To assess whether sleep-disordered breathing (SDB), ranging from primary snoring to obstructive sleep apnea (OSA), is associated with increased behavioral morbidity.
  
  
  METHODS
  A cross-sectional study was conducted of school-aged children in an urban, community-based cohort, stratified for term or preterm (<37 weeks' gestation) birth status. A total of 829 children, 8 to 11 years old (50% female, 46% black, 46% former preterm birth) were recruited from a cohort study. All children had unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate for measurement of the apnea hypopnea index (number of obstructive apneas and hypopneas per hour). SDB was defined by either parent-reported habitual snoring or objectively measured OSA. Functional outcomes were assessed with 2 well-validated parent ratings of behavior problems: the Child Behavioral Checklist and the Conners Parent Rating Scale-Revised:Long.
  
  
  RESULTS
  Forty (5%) children were classified as having OSA (median apnea hypopnea index: 7.1 per hour; interquartile range: 3.1-10.5), 122 (15%) had primary snoring without OSA, and the remaining 667 (80%) had neither snoring nor OSA. Children with SDB had significantly higher odds of elevated problem scores in the following domains: externalizing, hyperactive, emotional lability, oppositional, aggressive, internalizing, somatic complaints, and social problems.
  
  
  CONCLUSIONS
  Children with relatively mild SDB, ranging from primary snoring to OSA, have a higher prevalence of problem behaviors, with the strongest, most consistent associations for externalizing, hyperactive-type behaviors.
authors.affiliation: Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, 11100 Euclid Ave, RB&C 790 Mail Stop 6003, Cleveland, OH 44106-6003, USA. carol.rosen@case.edu
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.forename: Judith L
authors.initials: JL
authors.lastname: Emancipator
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000209:etiology*; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000523:psychology*; D012913:Snoring / Q000523:psychology; D011795:Surveys and Questionnaires