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Inattention, Hyperactivity, and Symptoms of Sleep-Disordered Breathing
Abstract
OBJECTIVE: Inattention and hyperactivity are frequent among children with sleep-disordered breathing (SDB) and often improve when SDB is treated. However, the frequency of SDB symptoms among inattentive and hyperactive children has received little study. DESIGN: Cross-sectional survey. SETTING: Two university-affiliated but community-based general pediatrics clinics. PATIENTS: Patients consisted of N = 866 children (469 boys), aged 2.0 to 13.9 years (mean: 6.8 plus minus 3.2 years), with clinic appointments. MEASURES: A validated Pediatric Sleep Questionnaire assessed for habitual snoring (1 item), snoring severity (a 4-item subscale), sleepiness (4 items), and overall risk of SDB (16 items). Parents also completed 2 common behavioral measures, an inattention/hyperactivity scale (IHS) derived from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the hyperactivity index (HI, expressed as a t score) of the Conners' Parent Rating Scale. RESULTS: Habitual snoring was reported in 16% (95% confidence interval [CI]: 13, 19) of the participants. High HI scores (>60) were found in 13% (95% CI: 11, 16) of all participants, 22% (95% CI: 15, 29) of habitual snorers, and 12% (95% CI: 9, 14) of nonsnorers. Odds ratios between HI >60 and each of the following were: habitual snoring, 2.2 (95% CI: 1.4, 3.6); 1 additional positive symptom-item on the snoring scale, 1.3 (95% CI: 1.1, 1.5); 1 additional positive item on the sleepiness scale, 1.6 (95% CI: 1.4, 2.0); and a 1-standard deviation increase in the overall SDB score, 1.7 (95% CI: 1.4, 2.0; all odds ratios age- and sex-adjusted). Results were similar for high IHS scores (>1.25). Stratification by age and sex showed that most of the association with snoring (but not sleepiness) derived from boys <8 years old. CONCLUSIONS: Inattention and hyperactivity among general pediatric patients are associated with increased daytime sleepiness and---especially in young boys---snoring and other symptoms of SDB. If sleepiness and SDB do influence daytime behavior, the current results suggest a major public health impact.
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“SDB has been consistently associated with neurobehavioral and neurocognitive deficits, including inattentive or ADHD-like symptoms (Beebe 2006; Beebe et al. 2004; Chervin et al. 2002, 2012; Gottlieb et al. 2003; Lal et al. 2012; O’Brien 2009; Owens 2008; Rosen et al. 2004; Soylu et al. 2013; Suratt et al. 2011).”
From Associations of sleep disturbance with ADHD: implications for treatment (2015) · cites this paper as Chervin et al. 2002
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Oyegbile, T. O. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-51147-6.00010-7 · Cited by 4
Joseph, M., Lajili, M., Dudoignon, B., Delclaux, C., & Bokov, P. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.01.006 · Cited by 3
Airway changes in patients with sleep apnea using AdvanSync2 Class II correctors – a case series
Keerthana, P., Negi, G., & Chitra, P. (2021) · Medicine and Pharmacy Reports · doi:10.15386/mpr-1922 · Cited by 3
Yazıcı, Z. M., Bilgin, F. B., İnan, B. K., Abakay, M. A., & Sayın, İ. (2023) · Turkish Archives of Otorhinolaryngology · doi:10.4274/tao.2023.2023-10-1 · Cited by 3
The Impact of Adenotonsillectomy on Sleep and Behavior of Children with Obstructive Sleep Apnea
Ajith, A., Balu, R., Kumar, M., & Panikkar, S. (2021) · Indian Journal of Otolaryngology and Head & Neck Surgery · doi:10.1007/s12070-021-02593-x · Cited by 3
Metadata
- Authors
- Chervin, R. D., Archbold, K. H., Dillon, J. E., Panahi, P., Pituch, K. J., Dahl, R. E., & Guilleminault, C.
- Affiliations
- University of Michigan (US)
- University of Pittsburgh (US)
- Stanford University (US)
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2002-03-01
- Volume
- 109
- Issue
- 3
- Pages
- 449-456
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2075082585
- Cited by
- 538
- References
- 51
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 8 · 2023: 11 · 2022: 12 · 2021: 13 · 2020: 14 · 2019: 18 · 2018: 13 · 2017: 20 · 2016: 14 · 2015: 21 · 2014: 29 · 2013: 30 · 2012: 26
- FWCI
- 18.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Michigan
- National Institute of Neurological Disorders and Stroke (K02 NS02009, K02NS002009)
- National Center for Research Resources (M-01RR00042, M01RR000042)
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Keywords
- sleep-disordered breathing, snoring, inattention, hyperactivity, sleepiness, children, habitual snoring, Pediatric Sleep Questionnaire, Conners' Parent Rating Scale, sex differences, age differences, pediatric sleep medicine, daytime sleepiness, attention deficit hyperactivity disorder
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Disorders of Excessive Somnolence, Male, Surveys and Questionnaires, Sex Factors, Sleep Apnea Syndromes, Snoring, Logistic Models, Odds Ratio
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