ABSTRACT. Objective. To determine the prevalence of snoring and its potential associations with sleep problems, such as daytime symptoms, medical conditions, school performance, and behavioral disturbances in Portuguese children attending primary school.Methods. A previously validated questionnaire was sent to the parents of 1381 children attending primary schools in a parish of Coimbra, Portugal. To assess behavioral disturbances, the Portuguese version of Rutter's Children's Behavior Questionnaire for completion by teachers was used.Results. Of the 988 questionnaires returned (71.5%), complete information concerning snoring was obtained for 976 children (496 girls and 480 boys; mean age: 8.1 ؎ 1.5 years). Loud snoring during sleep was reported as frequent or constantly present (LSn) in 84 children (8.6%), as occasionally present in 299 children (30.6%), and as never present (NSn) by 593 children (60.8%). The LSn and NSn groups did not differ with respect to age, gender, sleep duration, time to fall asleep, frequency of night wakings, bedwetting, daytime tiredness, and school achievement. However, LSn was significantly associated with increased bedtime problems (fears and struggles), increased need for comforting activities to fall asleep, behaviors suggestive of parasomnias (sleep talking, teeth grinding, and night terrors), increased daytime sleepiness and irritability, and behavioral disturbances. Children in the LSn group were also more likely to report recurrent medical problems particularly those involving infections of the respiratory tract.Conclusions. Snoring is a common symptom in Portuguese children that is associated with behavioral daytime and sleep time disturbances. Children with loud snoring may benefit from early evaluation and intervention. Pediatrics 2000;106(5). URL: http://www. pediatrics.org/cgi/content/full/106/5/e64; snoring, children, epidemiology, sleep patterns, behavior.

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Keywords:Insomnia Hyperarousal Default-mode network Cognitive-behavioral therapy for insomnia a b s t r a c t Psychophysiological insomnia (PI) is a common sleep disorder in which numerous variables interact. The mechanisms responsible for the etiology and maintenance of PI, though far from completely understood, point to the existence of hyperarousal of several systems. The frequent occurrence of ruminations and worries with a self-referential component (related or not with sleep complaints) during the pre-sleep period, and daytime wakefulness, seems to relate to the functions which have been associated with default-mode network (DMN) activity. This neural network seems to be involved in introspective thinking as well as emotional and episodic memory processing, among others. In this paper, we propose that PI may be conceptualized as a disorder associated with overactivity of some brain areas of DMN. Accordingly, it is also suggested that cognitive-behavioral therapy for insomnia (CBT-I), a kind of non-pharmacological treatment, may alter the function of this network, improving symptoms of patients, and overall quality of life.

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Primary insomnia (PI) is one of the most prevalent sleep disorders. For this reason, over the last decades, several comprehensive and etiological theories have been proposed. In this paper we review some of the main theoretical models of insomnia and discuss the two most studied processes for comprehension of insomnia: the hyperarousal and the failure to inhibit wakefulness or psychobiological inhibition hypotheses. Some clinical implications of the models are described. In the end, we propose that the two processes are complementary and both are relevant to the understanding of clinical insomnia.

This study aimed primarily to compare the parent-reported sleep of children with ICD-10 hyperkinetic disorder (HKD) versus community children. Thirty children aged 5-13 years (83.3% boys) diagnosed with HKD by their child and adolescent psychiatrists took part in this study, plus 30 community children, matched for sex, age, and school year. Compared to the controls, the HKD children showed significantly later bedtimes, stronger bedtime resistance, longer sleep latency, shorter sleep; more frequent behaviors and symptoms concerning falling asleep into parents bed, needing something special to initiate sleep, nightmares, sleep talking, sleep bruxism, fear from darkness, bedwetting, and, most notably, loud snoring (26.7%); they also tended to show higher daytime somnolence. Attention deficit/hyperactivity disorder (ADHD)/HKD children may thus have more sleep-related problems than typically developing children. Alternatively, our results may reflect misdiagnoses; thus, special attention should be directed to comorbidity and differential diagnosis issues between sleep disturbances and ADHD/HKD.

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