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Judith A. Owens, MD, MPH; Robyn Mehlenbeck, PhD; Juhee Lee, BA; Melissa M. King, MD

Arch Pediatr Adolesc Med. 2008;162(4):313-321.

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.

Design  Medical record review.

Setting  Academic pediatric medical center.

Participants  Clinical sample of 235 children aged 3 to 18 years undergoing overnight polysomnography for symptoms of SDB.

Outcome Measures  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 perent 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.

Author Affiliations: Department of Pediatrics, Alpert Medical School, Brown University, Rhode Island Hospital, Providence (Dr Owens); Department of Psychology, Alpert Medical School, Brown University, Bradley Hasbro Children's Research Center, Providence, Rhode Island (Dr Mehlenbeck); Rhode Island Hospital, Providence (Ms Lee); and Wilford Hall Medical Center, Lackland Air Force Base, Texas (Dr King).

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