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Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years.
Pediatrics 2012; 129(4):e857-65Ped

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 ≈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.

Authors+Show Affiliations

Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA. karen.bonuck@einstein.yu.edu

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

22392181

Citation

Bonuck, Karen, et al. "Sleep-disordered Breathing in a Population-based Cohort: Behavioral Outcomes at 4 and 7 Years." Pediatrics, vol. 129, no. 4, 2012, pp. e857-65.
Bonuck K, Freeman K, Chervin RD, et al. Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years. Pediatrics. 2012;129(4):e857-65.
Bonuck, K., Freeman, K., Chervin, R. D., & Xu, L. (2012). Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years. Pediatrics, 129(4), pp. e857-65. doi:10.1542/peds.2011-1402.
Bonuck K, et al. Sleep-disordered Breathing in a Population-based Cohort: Behavioral Outcomes at 4 and 7 Years. Pediatrics. 2012;129(4):e857-65. PubMed PMID: 22392181.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years. AU - Bonuck,Karen, AU - Freeman,Katherine, AU - Chervin,Ronald D, AU - Xu,Linzhi, Y1 - 2012/03/05/ PY - 2012/3/7/entrez PY - 2012/3/7/pubmed PY - 2012/6/14/medline SP - e857 EP - 65 JF - Pediatrics JO - Pediatrics VL - 129 IS - 4 N2 - 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 ≈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. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/22392181/abstract/Sleep_Disordered_Breathing_in_a_Population_Based_Cohort:_Behavioral_Outcomes_at_4_and_7_Years_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=22392181 DB - PRIME DP - Unbound Medicine ER -