Objective
To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma.
Patients and Methods
We examined data for 194 children (age 4–10 yrs) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed using the Sleep-Related Breathing Disorder (SRBD) questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the SRBD by removing the 6 attention/hyperactivity items. A sleep score of >.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI) which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores.
Results
The majority of children (mean age 8.2 yrs) were male (56%), African American (66%), and insured by Medicaid (73%). Overall, 33% of children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared to children without SDB on total BPI (13.7 vs 8.8, p<.001), externalizing (9.4 vs 6.3, p<.001), internalizing (4.4 vs 2.5, p<.001), anxious/depressed (2.4 vs 1.3, p<.001), headstrong (3.2 vs 2.1, p<.001), antisocial (2.3 vs 1.7, p=.013), hyperactive (3.0 vs 1.8, p<.001), peer conflict (.74 vs .43, p=.011), and immature (2.0 vs 1.5, p=.001). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI, externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SBD subscales (snoring, sleepiness).
Conclusions
We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from further intervention.