title: Effect of weight, sleep duration, and comorbid sleep disorders on behavioral outcomes in children with sleep-disordered breathing.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Medical record review.
  
  
  METHODS
  Academic pediatric medical center.
  
  
  METHODS
  Clinical sample of 235 children aged 3 to 18 years undergoing overnight polysomnography for symptoms of SDB.
  
  
  METHODS
  History of behavioral, emotional, and academic problems and Child Behavior Checklist (CBCL) scores.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rhode Island Hospital, 593 Eddy St, Potter Bldg, Ste 200, Providence, RI 02903, USA. owensleep@gmail.com
authors.forename: Judith A
authors.initials: JA
authors.lastname: Owens
authors.forename: Robyn
authors.initials: R
authors.lastname: Mehlenbeck
authors.forename: Juhee
authors.initials: J
authors.lastname: Lee
authors.forename: Melissa M
authors.initials: MM
authors.lastname: King
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002648:Child; D002653:Child Behavior Disorders / Q000145:classification / Q000209:etiology*; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008499:Medical Records; D050177:Overweight / Q000150:complications*; D017286:Polysomnography; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D012893:Sleep Wake Disorders / Q000145:classification / Q000150:complications*; D011795:Surveys and Questionnaires