Risk factors and consequences of excessive autonomic activation during sleep in children.
OBJECTIVE
The aim of this study was to assess risk factors for excessive autonomic activation during sleep (EAAS) and its association with sleep problems, impaired behavior, and poor academic performance in primary school children.


METHODS
Data from a community-based study on 997 primary school children were used. Based on nocturnal home pulse oximetry, autonomic activation during sleep was defined as a pulse rate increase by more than 20%. Children with ≥35.9 autonomic activations per hour (i.e., ≥ the 95(th) centile) were classified as suffering from EAAS and compared with controls. Sleep problems, impaired behavior, and academic performance were assessed by parental questionnaires and analysis of school reports.


RESULTS
According to the above-mentioned definition, EAAS was diagnosed in 52 children (67% male). Risk factors for EAAS were male gender (odds ratio [95% confidence interval]: 2.06 [1.14-3.72]) and presence of symptoms of sleep-disordered breathing (3.48 [1.29-9.43]). Children with EAAS had a higher prevalence of hyperactive behavior (39.2% vs. 26.0%; p = 0.05) and enuresis (5.8% vs. 0.8%; p = 0.017) but not of poor academic performance. The association with hyperactive behavior was confirmed in a subsample (n = 119) using the Strengths and Difficulties Questionnaire. Mean (SD) score of the hyperactive-inattentive scale was 4.5 (2.8) for EAAS and 3.4 (2.7) for non-EAAS (p = 0.04).


CONCLUSIONS
EAAS may be a marker of sleep disruption in children and may predict the occurrence of enuresis and hyperactive behavior.
Brockmann
Pablo E
PE
Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
Urschitz
Michael S
MS
Noehren
Anke
A
Sokollik
Christiane
C
Schlaud
Martin
M
Poets
Christian F
CF
D000124:Achievement; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004775:Enuresis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005858:Germany; D006339:Heart Rate / Q000502:physiology; D006699:Home Care Services; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D010092:Oximetry; D017286:Polysomnography; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D013223:Statistics as Topic
Am J Respir Crit Care Med. 2002 Apr 15;165(8):1048-54
11956043
Sleep Med. 2009 Apr;10(4):446-56
18693137
Chest. 2003 Jan;123(1):96-101
12527608
Acta Paediatr. 2000 Feb;89(2):223-8
10709895
Paediatr Respir Rev. 2002 Mar;3(1):3-9
12065176
Acta Paediatr. 2005 Nov;94(11):1619-25
16303700
Brain Dev. 1997 Nov;19(7):485-7
9408596
Sleep Med Rev. 2006 Apr;10(2):109-18
16488632
Scand J Urol Nephrol. 2000 Oct;34(5):294-302
11186467
J Sleep Res. 1998 Mar;7(1):53-9
9613428
Sleep. 2000 Dec 15;23(8):1043-51
11145319
J Clin Sleep Med. 2007 Mar 15;3(2):201-40
17557427
Pediatr Res. 2003 Apr;53(4):580-8
12612196
Sleep. 2004 May 1;27(3):502-6
15164906
Sleep. 2002 Aug 1;25(5):579-83
12150325
Acta Paediatr. 2003 Oct;92(10):1118-23
14632323
Sleep. 1997 Dec;20(12):1157-61
9493926
J Pediatr. 1984 Jul;105(1):10-4
6737123
Pediatrics. 1998 Sep;102(3 Pt 1):616-20
9738185
Sleep Med Rev. 2006 Oct;10(5):323-37
16564189
Pediatrics. 2000 Feb;105(2):405-12
10654964
Tohoku J Exp Med. 2004 Sep;204(1):63-9
15329464
J Neurosci. 2001 Apr 1;21(7):2442-50
11264318
Scand J Urol Nephrol. 2001 Oct;35(5):350-6
11771860
Pediatrics. 2004 Oct;114(4):1041-8
15466103
Pediatrics. 2003 Mar;111(3):554-63
12612236
J Sleep Res. 2002 Mar;11(1):1-16
11869421
Arch Pediatr Adolesc Med. 2000 Jun;154(6):549-55
10850500
Sleep. 1997 Dec;20(12):1185-92
9493930
Sleep. 2006 Apr;29(4):504-11
16676784
Pediatrics. 2006 Mar;117(3):e496-502
16510628
Arch Otolaryngol Head Neck Surg. 2007 Oct;133(10):980-4
17938320
Sleep. 1997 Feb;20(2):151-7
9143075
Pediatrics. 1999 Jun;103(6 Pt 1):1193-7
10353928
J Clin Sleep Med. 2007 Feb 15;3(1):41-7
17557452
J Sleep Res. 2007 Mar;16(1):96-101
17309768
Sleep Breath. 2009 May;13(2):137-46
18807079
J Child Psychol Psychiatry. 1997 Jul;38(5):581-6
9255702
Paediatr Perinat Epidemiol. 2004 Nov;18(6):431-40
15535819
J Sleep Res. 1996 Dec;5(4):251-61
9065877
J Appl Physiol (1985). 1996 Dec;81(6):2651-7
9018518
Eur Child Adolesc Psychiatry. 2000 Dec;9(4):271-6
11202102
Crit Care Med. 2000 May;28(5):1565-8
10834712
Pediatr Pulmonol. 2010 May;45(5):459-68
20425853
Z Kinder Jugendpsychiatr Psychother. 2002 May;30(2):105-12
12053874