Snoring Tots More Likely to Turn into Troubled Kids (CME/CE)
supports that conclusion, but only multicenter, randomized controlled trials, like the ongoing National Institutes of Health–funded Childhood Adenotonsillectomy study, can prove the cause-and-effect relationships, Bonuck's group noted.
Their study included more than 9,000 children in the Avon Longitudinal Study of Parents and Children, a birth cohort study of children in a region of southwest U.K.
Based on parent reports of children's snoring, mouth breathing, and witnessed apnea for ages 6 to 69 months, the children were broken into five "clusters" for presence and duration of sleep-disordered breathing.
Early clusters were defined as: Cluster 1: Symptoms peaked at 6 months and then abated Cluster 2: Symptoms peaked at 18 months and then abated Cluster 3: Symptoms peaked at 30 months and then persisted ("worst case") Cluster 4: Symptoms emerged at 42 months and then persisted ("late symptom") Cluster 5: "Normals" who were asymptomatic throughout
Five comparable later clusters demonstrated similar patterns to the early clusters, except in a "late symptom" cluster where snoring and mouth breathing peaked together at lower levels at 57 months with no marked apnea.
Compared with the 45% of kids with no symptoms, all the other groups showed significantly elevated risk of being in the worst 10% for behavioral screening score on the Strengths and Difficulties Questionnaire (all P <0.01 or P <0.05).
The 8% of "worst case" kids (cluster 3) had 49% elevated risk of being in the top 10% for total behavioral problem score at age 4 and up to two-fold excess risk at age 7.
Hyperactivity was the outcome most consistently associated with symptomatic sleep-disordered breathing across the groups.
Significant odds ratios for hyperactivity at age 4 ranged from 1.19 for the 20% in cluster 1, whose symptoms abated after peaking at 6 months, to 1.56 for the "worst case" group (cluster 3).
For hyperactivity at age 7, the odds ranged from 1.48 for cluster 1 to 1.88 for the 20% of kids with symptoms in cluster 2.
Conduct problems, such as aggressiveness and rule breaking, showed associations similar to those with emotional problems.