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Association Between Sleep Disordered Breathing and Behavior in School-Aged Children: The Tucson Children's Assessment

Qiuhong Zhao1, Duane L Sherrill, James L Goodwin

  • 1SIROW, College of Social and Behavioral Sciences, University of Arizona, AZ, USA.

The Open Epidemiology Journal
|June 24, 2008
PubMed

Insights

Sleep-disordered breathing (SDB) in children is linked to increased behavior problems, including aggression and social issues. This study proposes specific thresholds for the Respiratory Disturbance Index (RDI) to identify children at higher risk for these issues.

Area of Science:

  • Pediatric Sleep Medicine
  • Child Psychology
  • Respiratory Physiology

Background:

  • Sleep-disordered breathing (SDB) is increasingly recognized as a potential contributor to behavioral issues in children.
  • The Respiratory Disturbance Index (RDI) is a key metric for quantifying SDB severity.
  • Understanding the relationship between SDB severity and specific behavioral outcomes is crucial for early intervention.

Purpose of the Study:

  • To analyze the association between RDI and behavioral measures (CPRS-R, CBCL) in school-aged children.
  • To determine optimal RDI thresholds indicative of increased risk for behavior problems.
  • To investigate specific behavioral domains affected by SDB.

Main Methods:

  • Utilized data from the Tucson Children's Assessment of Sleep Apnea Study (TuCASA) cohort.
  • Included 403 children aged 6-11 with polysomnography (PSG) and behavioral data.
  • Employed logistic regression to assess SDB risk, using three RDI definitions (RDI0, RDI2, RDI3) and dichotomized behavioral scores (cutoff of 65).

Main Results:

  • No strictly linear progression of risk was observed across RDI categories for clinically significant behavioral scores.
  • Proposed RDI thresholds for SDB: RDI0 ≥ 7, RDI2 ≥ 2, and RDI3 ≥ 0.5 events/hour.
  • Significant associations found between SDB and oppositional, social, psychosomatic, somatic complaints, and aggressive behaviors.

Conclusions:

  • Sleep-disordered breathing in school-aged children is associated with an increased risk of behavioral problems.
  • Specific behaviors affected include somatic complaints, oppositional/aggressive behaviors, and social problems.
  • Recommended RDI cutoffs are 7 for RDI0, 2 for RDI2, and 0.5 for RDI3 to indicate clinically significant SDB.

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