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Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders
1Department of Pediatrics, Hasbro Children's Hospital and Brown University School of Medicine, Providence, Rhode Island, USA.
Insights
Children with obstructive sleep apnea syndrome (OSAS) and comorbid behavioral sleep disorders (BSD) experience shortened sleep and more daytime behavior problems. Evaluating for BSD is crucial in children with OSAS.
Area of Science:
- Pediatric Sleep Medicine
- Behavioral Sleep Medicine
- Child Psychology
Background:
- Obstructive sleep apnea syndrome (OSAS) is a primary medical sleep disorder in children.
- Behavioral sleep disorders (BSD) are common in pediatric populations.
- The interplay between OSAS and BSD requires further investigation.
Purpose of the Study:
- To compare bedtime and daytime behaviors in children with OSAS versus BSD.
- To investigate the impact of comorbid BSD on sleep and daytime consequences in children with OSAS.
Main Methods:
- A 3-year study compared children with OSAS (n=100) and BSD (n=52) using parent-reported measures.
- Parent reports assessed sleep-disordered breathing, sleep behaviors, bedtime behaviors, and daytime externalizing behaviors.
- The OSAS group was sub-categorized into pure OSAS (n=78) and OSAS with comorbid BSD (n=22).
Main Results:
- Nearly 25% of children with OSAS also had significant behavioral sleep problems, mainly bedtime resistance.
- Bedtime resistance was linked to shorter sleep duration in both BSD and OSAS-BSD groups.
- Children with OSAS and comorbid BSD exhibited more daytime externalizing behaviors despite less severe OSAS.
Conclusions:
- Comorbid BSD should be evaluated in all children presenting with OSAS symptoms.
- The presence of BSD can significantly contribute to sleep deprivation and behavioral issues in children with OSAS.
Objective:
The purpose of this study was: 1) to examine both bedtime sleep behaviors and daytime behaviors associated with daytime sleepiness in a group of children with a primary medical sleep disorder (obstructive sleep apnea syndrome [OSAS]) compared with a group of children with a primary behavioral sleep disorder (BSD) (limit setting sleep disorder or sleep onset association disorder); and 2) to investigate the impact of a comorbid BSD on sleep and daytime behavioral consequences of OSAS.
Methods:
Children referred to a pediatric sleep disorders clinic during a 3-year period with a primary diagnosis of either polysomnographically-confirmed OSAS (n = 100) or a BSD (n = 52) were compared on several parent report measures assessing the following domains: symptoms of sleep disordered breathing, other sleep behaviors (primarily parasomnias), bedtime behaviors, and externalizing daytime behavior problems. The OSAS sample was then divided into a pure OSAS group (n = 78) and an OSAS plus a behavioral sleep diagnosis group (n = 22) based on the presence or absence of delayed sleep onset and/or prolonged nightwakings and compared on the parent-report symptom domains.
Results:
Almost one-quarter of the OSAS group had clinically significant behavioral sleep problems, primarily bedtime resistance, in addition to OSAS. Bedtime resistance was associated with a significantly shortened sleep duration in both the BSD and OSAS-BSD groups. Although the OSAS-BSD group had less severe disease, as defined by polysomnographic variables, than the pure OSAS group, they were rated by their parents as having more daytime externalizing behavior problems associated with daytime sleepiness.
Conclusions:
The results of this study suggest that evaluation for comorbid BSD should be done in all children presenting with symptoms of OSAS. The coexistence of such BSDs may contribute significantly to sleep deprivation, and thus to behavioral manifestations of daytime sleepiness in these children.