title: Snoring predicts hyperactivity four years later.
abstract: OBJECTIVE
  Cross-sectional studies implicate snoring and sleep-disordered breathing as potential contributors to hyperactive behavior in some children. However, no prospective cohort study has demonstrated that symptoms of sleep-disordered breathing precede development of hyperactivity.
  
  
  METHODS
  Parents of 229 children aged 2 to 13 years, recruited at 2 general pediatrics clinics, completed initial and 4-year follow-up surveys.
  
  
  METHODS
  Surveys included a validated Pediatric Sleep Questionnaire about snoring, sleepiness, and overall risk of sleep-disordered breathing, and the hyperactivity index (expressed as a T-score) within the Conners' Parent Rating Scale.
  
  
  RESULTS
  Thirty children (13%) were rated as hyperactive (hyperactivity index > 60) at follow-up. After adjustment for hyperactivity at baseline and stimulant use at follow-up, hyperactivity at follow-up was predicted by baseline habitual snoring (odds ratio = 4.4, 95% confidence interval [1.3, 14.7]) or loud snoring (4.5, [1.2, 17.5]) and by top-quartile composite scores for snoring (5.3, [1.7, 16.8]), sleepiness (3.0, [1.0, 9.4]), or sleep-disordered breathing (4.0, [1.4, 11.6]).
  
  
  CONCLUSIONS
  This 4-year prospective cohort study shows that snoring and other symptoms of sleep-disordered breathing are strong risk factors for future emergence or exacerbation of hyperactive behavior. These findings support the hypothesis that untreated childhood sleep-disordered breathing contributes to development of hyperactivity.
authors.affiliation: Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, USA. chervin@umich.edu
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Ruzicka
authors.forename: Kristen Hedger
authors.initials: KH
authors.lastname: Archbold
authors.forename: James E
authors.initials: JE
authors.lastname: Dillon
mesh_terms: D017668:Age of Onset; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors