title: Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years.
abstract: OBJECTIVE
  Examine statistical effects of sleep-disordered breathing (SDB) symptom trajectories from 6 months to 7 years on subsequent behavior.
  
  
  METHODS
  Parents in the Avon Longitudinal Study of Parents and Children reported on children's snoring, mouth breathing, and witnessed apnea at ≥2 surveys at 6, 18, 30, 42, 57, and 69 months, and completed the Strengths and Difficulties Questionnaire at 4 (n = 9140) and 7 (n = 8098) years. Cluster analysis produced 5 "Early" (6-42 months) and "Later" (6-69 months) symptom trajectories ("clusters"). Adverse behavioral outcomes were defined by top 10th percentiles on Strengths and Difficulties Questionnaire total and subscales, at 4 and 7 years, in multivariable logistic regression models.
  
  
  RESULTS
  The SDB clusters predicted ≈20% to 100% increased odds of problematic behavior, controlling for 15 potential confounders. Early trajectories predicted problematic behavior at 7 years equally well as at 4 years. In Later trajectories, the "Worst Case" cluster, with peak symptoms at 30 months that abated thereafter, nonetheless at 7 years predicted hyperactivity (1.85 [1.30-2.63]), and conduct (1.60 [1.18-2.16]) and peer difficulties (1.37 [1.04-1.80]), whereas a "Later Symptom" cluster predicted emotional difficulties (1.65 [1.21-2.07]) and hyperactivity (1.88 [1.42-2.49]) . The 2 clusters with peak symptoms before 18 months that resolve thereafter still predicted 40% to 50% increased odds of behavior problems at 7 years.
  
  
  CONCLUSIONS
  In this large, population-based, longitudinal study, early-life SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood. Findings suggest that SDB symptoms may require attention as early as the first year of life.
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA. karen.bonuck@einstein.yu.edu
authors.forename: Karen
authors.initials: K
authors.lastname: Bonuck
authors.forename: Katherine
authors.initials: K
authors.lastname: Freeman
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.forename: Linzhi
authors.initials: L
authors.lastname: Xu
mesh_terms: D000328:Adult; D017677:Age Distribution; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology*; D011159:Population Surveillance; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors