Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing

Abstract

Children with relatively mild SDB, ranging from primary snoring to OSA, have a higher prevalence of problem behaviors, with the strongest, most consistent associations for externalizing, hyperactive-type behaviors.

Behavioral Problems and Neurocognitive Functioning in Snoring School-Aged Children

“…Teachers rated children with lower scores than parents. 6,7,19 Hypothesis concerning elevated externalizing behavioral problems was not confirmed; in contrast to previous studies, 11 current results do not support the association between snoring and externalizing behavioral problems, especially hyperactivity, oppositional and aggressive behavior in snoring children. In this study, externalizing symptoms were no more frequent in snorers than non-snorers.…”

“…6 The strongest associations for externalizing behaviors include hyperactivity, impulsivity, emotional lability, delinquency, conduct problems, aggressive behavior, and oppositional behavior. [7][8][9][10][11][12][13][14] Snoring children have also internalizing problems, showing more anxious/depressed mood, somatic complaints, withdrawal, thought problems, and social problems. [10][11][12][13][15][16][17][18] A few studies have used teacher reports, 6,7,19 showing that teachers report substantially fewer problems than parents.…”

“…Based on previous studies it was hypothesized that school-aged snoring children have elevated scores on problem behavior. 7,8,11,13,16 In addition, it was hypothesized that snoring school-aged children perform worse than non-snoring peers in neurocognitive functioning, showing a diffuse pattern with various mild impairments in attention, executive function, verbal and global intelligence, and memory. 21,26…”

The Relationship between Depressive Symptoms and Obstructive Sleep Apnea in Pediatric Populations: A Meta-Analysis

“…First, several studies included children with PS in the OSA group, possibly lowering the ES for the relationship between depressive symptoms and OSA. 1,30,35,36,81 However, when the 4 studies including children with PS were compared to OSA children as measured by depressive symptoms, the ES was almost zero (Hedges' g = 0.04, p = 0.76), 29,32,37,57 indicating that the inclusion of children with PS likely did not lower the strength of relationship between OSA and depressive symptoms. This was maintained when incorporating only the 3 studies that used the strict criteria for PS.…”

“…28 Eleven studies satisfied the inclusion criteria. 1,[29][30][31][32][33][34][35][36][37][38] To avoid publication bias, our team searched for unpublished data including dissertations. Two unpublished dissertations were found; one was excluded due to the lack of a depression measure, 39 and the other for the lack of PSG.…”