This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Owens, J.
Right arrow Articles by Spirito, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Owens, J.
Right arrow Articles by Spirito, A.
Related Collections
Right arrow Office Practice

PEDIATRICS Vol. 102 No. 5 November 1998, pp. 1178-1184

Sleep and Daytime Behavior in Children With Obstructive Sleep Apnea and Behavioral Sleep Disorders

Received Mar 6, 1998; accepted Jun 30, 1998.

Judith Owens*, Lisa OpipariDagger , Chantelle NobileDagger , and Anthony SpiritoDagger

From the Departments of * Pediatrics and Dagger  Child and Family Psychiatry, Hasbro Children's Hospital and Brown University School of Medicine, Providence, Rhode Island.

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.  Key words:  obstructive sleep apnea syndrome, bedtime resistance, daytime behavior, daytime sleepiness.




This article has been cited by other articles:


Home page
 Arch Pediatr Adolesc MedHome page
J. A. Owens, R. Mehlenbeck, J. Lee, and M. M. King
Effect of Weight, Sleep Duration, and Comorbid Sleep Disorders on Behavioral Outcomes in Children With Sleep-Disordered Breathing
Arch Pediatr Adolesc Med, April 1, 2008; 162(4): 313 - 321.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
O. S. Capdevila, L. Kheirandish-Gozal, E. Dayyat, and D. Gozal
Pediatric Obstructive Sleep Apnea: Complications, Management, and Long-term Outcomes
Proceedings of the ATS, February 15, 2008; 5(2): 274 - 282.
[Abstract] [Full Text] [PDF]

Home page
 J Child NeurolHome page
C. Bursztein, T. Steinberg, and A. Sadeh
Sleep, Sleepiness, and Behavior Problems in Children With Headache
J Child Neurol, December 1, 2006; 21(12): 1012 - 1019.
[Abstract] [PDF]

Home page
 ChestHome page
M. Moore, D. Allison, and C. L. Rosen
A review of pediatric nonrespiratory sleep disorders.
Chest, October 1, 2006; 130(4): 1252 - 1262.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
A. D. Goldbart, J. Krishna, R. C. Li, L. D. Serpero, and D. Gozal
Inflammatory Mediators in Exhaled Breath Condensate of Children With Obstructive Sleep Apnea Syndrome.
Chest, July 1, 2006; 130(1): 143 - 148.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
L. F. Donnelly
Obstructive Sleep Apnea in Pediatric Patients: Evaluation with Cine MR Sleep Studies
Radiology, September 1, 2005; 236(3): 768 - 778.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
A. D. Goldbart, J. L. Goldman, M. C. Veling, and D. Gozal
Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children
Am. J. Respir. Crit. Care Med., August 1, 2005; 172(3): 364 - 370.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
C. L. Rosen, A. Storfer-Isser, H. G. Taylor, H. L. Kirchner, J. L. Emancipator, and S. Redline
Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing
Pediatrics, December 1, 2004; 114(6): 1640 - 1648.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
M. B. Abbott, L. F. Donnelly, B. J. Dardzinski, S. A. Poe, B. A. Chini, and R. S. Amin
Obstructive Sleep Apnea: MR Imaging Volume Segmentation Analysis
Radiology, September 1, 2004; 232(3): 889 - 895.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. L. Bass, M. Corwin, D. Gozal, C. Moore, H. Nishida, S. Parker, A. Schonwald, R. E. Wilker, S. Stehle, and T. B. Kinane
The Effect of Chronic or Intermittent Hypoxia on Cognition in Childhood: A Review of the Evidence
Pediatrics, September 1, 2004; 114(3): 805 - 816.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
S Blunden, K Lushington, B Lorenzen, T Ooi, F Fung, and D Kennedy
Are sleep problems under-recognised in general practice?
Arch. Dis. Child., August 1, 2004; 89(8): 708 - 712.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
L. M. O'Brien, C. B. Mervis, C. R. Holbrook, J. L. Bruner, C. J. Klaus, J. Rutherford, T. J. Raffield, and D. Gozal
Neurobehavioral Implications of Habitual Snoring in Children
Pediatrics, July 1, 2004; 114(1): 44 - 49.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
H. E. Montgomery-Downs, V. F. Jones, V. J. Molfese, and D. Gozal
Snoring in Preschoolers: Associations with Sleepiness, Ethnicity, and Learning
Clinical Pediatrics, October 1, 2003; 42(8): 719 - 726.
[Abstract] [PDF]

Home page
 ChestHome page
J. L. Goodwin, S. I. Babar, K. L. Kaemingk, G. M. Rosen, W. J. Morgan, D. L. Sherrill, and S. F. Quan
Symptoms Related to Sleep-Disordered Breathing in White and Hispanic Children: The Tucson Children's Assessment of Sleep Apnea Study
Chest, July 1, 2003; 124(1): 196 - 203.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
L. F. Donnelly, V. Surdulescu, B. A. Chini, K. A. Casper, S. A. Poe, and R. S. Amin
Upper Airway Motion Depicted at Cine MR Imaging Performed during Sleep: Comparison between Young Patients with and Those without Obstructive Sleep Apnea
Radiology, April 1, 2003; 227(1): 239 - 245.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
L. F. Donnelly, K. A. Casper, and B. Chen
Correlation on Cine MR Imaging of Size of Adenoid and Palatine Tonsils with Degree of Upper Airway Motion in Asymptomatic Sedated Children
Am. J. Roentgenol., August 1, 2002; 179(2): 503 - 508.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
L. F. Donnelly, K. A. Casper, B. Chen, and B. L. Koch
Defining Normal Upper Airway Motion in Asymptomatic Children during Sleep by Means of Cine MR Techniques
Radiology, April 1, 2002; 223(1): 176 - 180.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
L. Brunetti, S. Rana, M. L. Lospalluti, A. Pietrafesa, R. Francavilla, M. Fanelli, and L. Armenio
Prevalence of Obstructive Sleep Apnea Syndrome in a Cohort of 1,207 Children of Southern Italy
Chest, December 1, 2001; 120(6): 1930 - 1935.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
L. F. Donnelly, J. L. Strife, and C. M. Myer III
Is Sedation Safe During Dynamic Sleep Fluoroscopy of Children with Obstructive Sleep Apnea?
Am. J. Roentgenol., November 1, 2001; 177(5): 1031 - 1034.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
D. Gozal, M. Wang, and D. W. Pope Jr
Objective Sleepiness Measures in Pediatric Obstructive Sleep Apnea
Pediatrics, September 1, 2001; 108(3): 693 - 697.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
L. F. Donnelly, J. L. Strife, and C. M. Myer III
Glossoptosis (Posterior Displacement of the Tongue) During Sleep: A Frequent Cause of Sleep Apnea in Pediatric Patients Referred for Dynamic Sleep Fluoroscopy
Am. J. Roentgenol., December 1, 2000; 175(6): 1557 - 1560.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
A. M. Ferreira, V. Clemente, D. Gozal, A. Gomes, C. Pissarra, H. César, I. Coelho, C. F. Silva, and M. H. P. Azevedo
Snoring in Portuguese Primary School Children
Pediatrics, November 1, 2000; 106(5): 64e - 64.
[Abstract] [Full Text]

Home page
 Arch Pediatr Adolesc MedHome page
J. A. Owens, R. Maxim, C. Nobile, M. McGuinn, and M. Msall
Parental and Self-report of Sleep in Children With Attention-Deficit/Hyperactivity Disorder
Arch Pediatr Adolesc Med, June 1, 2000; 154(6): 549 - 555.
[Abstract] [Full Text] [PDF]