Hyperactivity and polysomnographic findings in children evaluated for sleep-disordered breathing
1Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, USA. chervin@umich.edu
Insights
Hyperactive behavior is common in children with suspected sleep-disordered breathing (SDB). Periodic leg movements during sleep (PLMS) may contribute to hyperactivity, independent of SDB severity.
Area of Science:
- Pediatric Sleep Medicine
- Behavioral Pediatrics
- Neurodevelopmental Disorders
Background:
- Hyperactivity is frequently observed in children with sleep-disordered breathing (SDB).
- Treatment of SDB often leads to improvement in hyperactive behaviors.
- The specific polysomnographic features linking SDB and hyperactivity require further investigation.
Purpose of the Study:
- To investigate the association between polysomnographic findings of SDB and hyperactive behavior in children.
- To determine if periodic leg movements during sleep (PLMS) are associated with hyperactivity in this population.
- To explore the potential role of SDB and PLMS in contributing to hyperactive symptoms.
Main Methods:
- Prospective, observational study conducted in a university-based sleep disorders laboratory.
- 113 children aged 2-18 years, referred for suspected SDB, underwent polysomnography.
- Parental rating scales (Connors' Parental Rating Scale) assessed hyperactivity, with results converted to age-adjusted t-scores.
Main Results:
- Hyperactivity scores were similarly high in children with and without SDB.
- Hyperactivity was not significantly associated with SDB severity metrics like apnea-hypopnea index or oxygen saturation.
- A significant association was found between hyperactivity and the presence of 5 or more periodic leg movements during sleep (PLMS) per hour (p=0.02).
- The rate of PLMS showed a linear association with hyperactivity in children with SDB (p=0.002).
Conclusions:
- Hyperactive behavior is prevalent in children referred for suspected SDB, irrespective of SDB diagnosis or severity.
- Findings suggest periodic leg movements during sleep (PLMS) may be a significant contributor to hyperactivity.
- While causality is not proven, PLMS may directly influence hyperactivity, and SDB might act as an effect modifier.
Study Objectives:
Children with sleep-disordered breathing (SDB) or periodic leg movements during sleep (PLMS) often have hyperactive behavior that improves when the sleep disorder is treated. Some children with SDB also have PLMS. To determine what polysomnographic features of SDB might be associated with hyperactive behavior, we studied behavior, SDB, and PLMS in a series of patients.
Design:
Prospective and observational.
Setting:
University-based sleep disorders laboratory.
Subjects:
Children (n=113) aged 2 to 18 years, referred for suspected SDB.
Interventions:
Parents completed the hyperactivity index of the Connors' Parental Rating Scale, and results were converted to age-adjusted t-scores. Children underwent laboratory-based polysomnography, with esophageal pressure monitoring when requested (n=19) by referring physicians.
Results:
Children with SDB (n=59) showed high hyperactivity scores (mean 59.5+/-18.3 SD, 95% C.I. [54.7, 64.2]) but these scores were no higher than those of children without SDB (59.0+/-15.1, [54.8, 63.1]). Hyperactivity showed no significant associations with the rate of apneas and hypopneas, minimum oxygen saturation, or most negative esophageal pressure (p>0.10), but was associated with the presence of 5 or more PLMS per hour (p=0.02). The rate of PLMS showed a linear association with hyperactivity among those subjects with SDB (p = 0.002), but no association among those subjects without SDB (p = 0.64).
Conclusions:
These findings suggest that hyperactive behavior is common among children referred for suspected SDB, regardless of the presence or severity of SDB. Current observations cannot prove causality, but they are consistent with the hypothesis that PLMS may contribute to hyperactivity and SDB may act as an effect modifier.
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