Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years

Journal Name: 
Pediatrics
Authors: 
Bonuck,K.
Freeman,K.
Chervin,R.D.
Xu,L.
Abstract: 
OBJECTIVES: Examine statistical effects of sleep-disordered breathing (SDB) symptom trajectories from 6 months to 7 years on subsequent behavior. METHODS: Parents in the Avon Longitudinal Study of Parents and Children reported on children's snoring, mouth breathing, and witnessed apnea at >/=2 surveys at 6, 18, 30, 42, 57, and 69 months, and completed the Strengths and Difficulties Questionnaire at 4 (n = 9140) and 7 (n = 8098) years. Cluster analysis produced 5 "Early" (6-42 months) and "Later" (6-69 months) symptom trajectories ("clusters"). Adverse behavioral outcomes were defined by top 10th percentiles on Strengths and Difficulties Questionnaire total and subscales, at 4 and 7 years, in multivariable logistic regression models. RESULTS: The SDB clusters predicted approximately 20% to 100% increased odds of problematic behavior, controlling for 15 potential confounders. Early trajectories predicted problematic behavior at 7 years equally well as at 4 years. In Later trajectories, the "Worst Case" cluster, with peak symptoms at 30 months that abated thereafter, nonetheless at 7 years predicted hyperactivity (1.85 [1.30-2.63]), and conduct (1.60 [1.18-2.16]) and peer difficulties (1.37 [1.04-1.80]), whereas a "Later Symptom" cluster predicted emotional difficulties (1.65 [1.21-2.07]) and hyperactivity (1.88 [1.42-2.49]) . The 2 clusters with peak symptoms before 18 months that resolve thereafter still predicted 40% to 50% increased odds of behavior problems at 7 years. CONCLUSIONS: In this large, population-based, longitudinal study, early-life SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood. Findings suggest that SDB symptoms may require attention as early as the first year of life
4
2012
Volume: 
129
Pages: 
e857-e865
Keywords: 
Adult, Age Distribution, analysis, Attention, Child, Child Behavior, Child Behavior Disorders, Child,Preschool, Cluster Analysis, Comparative Study, complications, Cross-Sectional Studies, effects, electronic, England, epidemiology, etiology, Family, Female, Follow-Up Studies, Humans, Incidence, Infant, Infant,Newborn, Life, Longitudinal Studies, Male, Medicine, Methods, Mouth Breathing, Parents, Population Surveillance, Pregnancy, psychology, Questionnaires, regression, Research, Research Support, Retrospective Studies, Risk Assessment, Risk Factors, Sex Distribution, Sleep Apnea Syndromes, Snoring, support, survey, Time Factors