Effect of weight, sleep duration, and comorbid sleep disorders on behavioral outcomes in children with sleep-disordered breathing.

OBJECTIVE To assess the relative contribution of potential risk factors for adverse neurobehavioral outcomes in children referred for evaluation of sleep-disordered breathing (SDB), including weight, mean sleep duration, and comorbid sleep disorders. DESIGN Medical record review. SETTING Academic pediatric medical center. PARTICIPANTS Clinical sample of 235 children aged 3 to 18 years undergoing overnight polysomnography for symptoms of SDB. OUTCOME MEASURES History of behavioral, emotional, and academic problems and Child Behavior Checklist (CBCL) scores. RESULTS More than half (56%) of the sample was overweight or at risk for overweight, more than one-third (36%) was classified as being short sleepers, and almost half (49%) had at least 1 additional sleep diagnosis. Forty-seven percent had a history of behavioral problems and 23% had a reported diagnosis of attention-deficit/hyperactivity disorder. There were no significant differences in CBCL scores based on any measure of SDB disease severity. Increased weight was associated with increased internalizing CBCL scores in a dose-dependent fashion (P = .003), while short sleepers were more likely to have elevated externalizing scores (P < .001). Overall, the strongest predictor of adverse behavioral outcomes was the presence of at least 1 additional sleep diagnosis (P < .001). CONCLUSIONS The relationship between SDB and parent-reported behavioral outcomes in children is complex. In addition to SDB-related impairments, clinicians should consider the relative contributions of being overweight, insufficient sleep, and comorbid sleep disorders when assessing behavior in these children.