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Kids' Sleep Problems Tied to Behavior Problems

Researchers urge parents, doctors to monitor habits

MONDAY, Oct. 6, 2003 (HealthDayNews) -- If your young child has sleep problems, don't be surprised if behavior problems follow.

Five-year-olds who had sleep-related breathing problems such as snoring were more likely to have daytime behavior problems like hyperactivity, lack of attention, and aggressiveness, according to a study in the October issue of Pediatrics.

Researchers from Chicago and Boston evaluated 3,019 children and asked their parents about sleep problems and then behavior problems during the day.

While previous research has linked snoring and other sleep problems such as apnea (involuntary breathing pauses during sleep), "the beauty of this study is that we controlled for several variables that others did not control for," says Dr. Debra E. Weese-Mayer, a professor of pediatrics at Rush University Medical Center in Chicago and a study co-author.

Among the factors controlled for, she adds, were gender, race, maternal educational level, and marital status, as well as respiratory health history, all of which could skew the outcomes.

Sleep-disordered breathing, which takes into account snoring, apnea, and other problems, was reported in one-fourth of the children. Then the researchers asked about daytime behavior.

Compared with children who didn't have snoring or other symptoms of sleep-disordered breathing, those with the problems were more likely to have behaviors associated with attention-deficit/hyperactivity disorder, or ADHD. They were two times more likely to have daytime sleepiness, 2.5 times more likely to have hyperactivity, and two times more likely to be inattentive or aggressive than the children without the nighttime sleep problems.

The study shows only an association, not cause-and-effect, between sleep problems and ADHD, Weese-Mayer says. But in the study, the authors conclude that the high prevalence of sleep-disordered breathing symptoms suggests they may contribute to the undesirable daytime behaviors.

About 5 percent of U.S. school-age children have ADHD, according to the National Institute of Mental Health.

The message for both parents and pediatricians, says Weese-Mayer, is to become more aware of sleep habits.

"It is really important to look at the whole child," Weese-Mayer says. "When you get behavioral issues in children, sometimes it is easy to forget that there are physiological problems that can exacerbate them."

Pediatricians should remember to ask about quality of sleep during checkups, she says.

Pediatricians should take into account any daytime behavior problems that might be associated with sleep problems when they are trying to decide whether to remove tonsils and adenoids, the authors say. The surgery often improves sleep problems.

Parents tend to monitor their babies' sleep by checking in on them often, but do it less so as children grow, says Weese-Mayer. She suggests they continue to keep an eye on their kids while in bed as they mature. "Look at your child while he is sleeping," she says.

If you hear loud snoring or observe what seems to be pauses in breathing, alert your pediatrician, she advises.

Earlier this year, the National Sleep Foundation issued information on children, obesity, and sleep. It noted that sleep apnea, while generally viewed as a problem among middle-aged, overweight men, can also be a problem for children, especially as the number of overweight children increases.

In a prepared statement, the foundation urges parents to be aware of nighttime and daytime symptoms of sleep apnea. They include snoring, breathing pauses during sleep, restless sleep, mouth breathing, and difficulty getting up even after enough sleep, and daytime inattention, behavior problems, and sleepiness.

More information

Read about obesity-related problems and children's sleep at the National Sleep Foundation, which also has a page on sleep tips.

SOURCES: Debra Weese-Mayer, M.D., professor of pediatrics, director of pediatric respiratory medicine, Rush University Medical Center, Chicago; October 2003 Pediatrics
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