Persistent Snoring in Preschool Children: Predictors and Behavioral and Developmental Correlates

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Loud snoring, which spikes at ∼2 to 3 years of age, has been associated with behavior problems in school-aged children in cross-sectional studies, but no longitudinal studies have quantified predictors and the behavioral impact of persistent snoring in preschool-aged children.WHAT THIS STUDY ADDS: Persistent loud snoring, which occurs in 9% of children 2 to 3 years of age, is linked with behavior problems. Higher socioeconomic status and a history of breastfeeding were associated with lower rates of transient and persistent snoring in young children. abstract OBJECTIVE: To clarify whether persistent snoring in 2-to 3-year-olds is associated with behavioral and cognitive development, and to identify predictors of transient and persistent snoring. METHODS:Two hundred forty-nine mother/child pairs participated in a prospective birth cohort study. Based upon parental report of loud snoring $2 times weekly at 2 and 3 years of age, children were designated as nonsnorers, transient snorers (snored at 2 or 3 years of age, but not both), or persistent snorers (snored at both ages). We compared groups by using validated measures of behavioral and cognitive functioning. Potential predictors of snoring included child race and gender, socioeconomic status (parent education and income), birth weight, prenatal tobacco exposure (maternal serum cotinine), childhood tobacco exposure (serum cotinine), history and duration of breast milk feeding, and body mass relative to norms. RESULTS:In multivariable analyses, persistent snorers had significantly higher reported overall behavior problems, particularly hyperactivity, depression, and inattention. Nonsnorers had significantly stronger cognitive development than transient and persistent snorers in unadjusted analyses, but not after demographic adjustment. The strongest predictors of the presence and persistence of snoring were lower socioeconomic status and the absence or shorter duration of breast milk feeding. Secondary analyses suggested that race may modify the association of childhood tobacco smoke exposure and snoring.CONCLUSIONS: Persistent, loud snoring was associated with higher rates of problem behaviors. These results support routine screening and tracking of snoring, especially in children from low socioeconomic backgrounds; referral for follow-up care of persistent snoring in young children; and encouragement and facilitation of infant breastfeeding. This manuscript has not been published elsewhere, and all authors approve of its submission for review. Each author made a substantive intellectual contribution to the study. Dr Beebe participated in early conceptualization and design of sleep measurement methodology, conducted preliminary analyses, and collaborated with coauthors on final analyses and data interpretation; he took the lead role with drafting and revising the manuscript. Dr Rausch provided critical contributions to formulating the data analytic plan, conducted final data analyses, assisted with data interpretation, and reviewed ...