title: Psychological screening for the children with habitual snoring.
abstract: OBJECTIVE
  Adenotonsillar hypertrophy is the major determinants of habitual snoring in pediatric population. Behavioral hyperactivity and schooling problems have been repeatedly reported in these children, and it may underlie more extensive behavioral disturbances, particularly for the obese children. The aim of the present study is to evaluate the incidence and characteristics of emotional and behavioral problems using outpatient-based psychological screening tools in the children with habitual snoring.
  
  
  METHODS
  Total 235 patients and 170 controls, who aged 4-9 years were enrolled. Body mass index (BMI) z-score was obtained for age and gender and parental sleep-related breathing disorder (SRBD) questionnaire was used to assess severity of sleep-disordered breathing (SBD). Psychological assessment was performed using standardized questionnaires including Strength and Difficulties Questionnaire (SDQ), Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Emotional Disorders (SCARED).
  
  
  RESULTS
  Children presenting habitual snoring had significantly higher mean scores on almost all scales of SDQ, and SCARED than community controls. Around 20% of the children with habitual snoring, compared with 10-11% of controls had significant levels of distress that could adversely impact treatment outcomes. There was no interaction between obstructive sleep apnea severity and behavioral ratings. The scores for emotional distress and hyperactivity were more prominent in the obese children. Significant psychological distress or impairment in social interactions was observed in children with higher SRBD scores.
  
  
  CONCLUSIONS
  Our findings suggest that the presence of habitual snoring in young children is associated wide spectrum of behavioral problems and the level of psychological distress might be evaluated at the time of the diagnosis.
authors.affiliation: Otorhinolaryngology Department, CHA University, Seongnam, Republic of Korea.
authors.forename: Chang Ho
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Otorhinolaryngology Department, CHA University, Seongnam, Republic of Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Otorhinolaryngology Department, CHA University, Seongnam, Republic of Korea.
authors.forename: Sun Bin
authors.initials: SB
authors.lastname: Lee
authors.affiliation: Otorhinolaryngology Department, CHA University, Seongnam, Republic of Korea.
authors.forename: Chan Kee
authors.initials: CK
authors.lastname: Yoo
authors.affiliation: Otorhinolaryngology Department, CHA University, Seongnam, Republic of Korea. Electronic address: hyoungkim1024@gmail.com.
authors.forename: Hyoung-Mi
authors.initials: HM
authors.lastname: Kim
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000523:psychology*; D012913:Snoring / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Anxiety; Depression; Obesity; Obstructive sleep apnea; Pediatric; Snoring