Snoring, sleep disturbance, and behaviour in 4-5 year olds.

Abstract

Parents of 996 children aged 4-5 years identified consecutively from the Oxford health visitor register were asked to complete a questionnaire about breathing disorders during sleep. A total of 782 (78.5%) was returned. Ninety five (12-1%) children were reported to snore on most nights. Habitual snoring was significantly associated with daytime sleepiness, restless sleep, and hyperactivity.The questionnaire responses were used to select two subgroups, one at high risk of a sleep and breathing disorder and a control group. These children (132 in total) were monitored at home with overnight video recording and oximetry, and had formal behavioural assessment using the Conners scale.Seven (7/66) children from the high risk group and none from the control group had obvious sleep disturbance consequent on snoring and upper airway obstruction. Thus our estimate of the prevalence of sleep and breathing disorders in this age group is 7/996 or 07%.The high risk group had significantly higher nocturnal movement, oxygen saturation dip rates, and overnight pulse rates than the controls. Maternal but not paternal smoking was associated with the high risk group. Parents and teachers thought those in the high risk group were more hyperactive and inattentive than the controls, but only their parents thought them more aggressive.Significant sleep and breathing disorders occur in about 07% of 4-5 year olds. Children whose parents report snoring and sleep disturbance have objective evidence of sleep disruption and show more behaviour problems than controls. This study has therefore addressed questions about the prevalence and psychological impact of undiagnosed sleep and breathing disorders in children: first, through a questionnaire survey about snoring and sleep problems in 996 randomly selected children aged 4 5-5 years; and second, by evaluating with home sleep studies and formalised behavioural assessments a high risk subgroup and comparing these children with a low risk control subgroup, with the two groups selected from the initial survey. Subjects QUESTIONNAIRE SURVEYNine hundred and ninety six boys and girls born consecutively between 8 January and 22 September 1985 and living in Oxford were identified from the centralised health visitor register. The ages at the time of study ranged from 4-5 to 5 * 5 years. SLEEP STUDY AND BEHAVIOURAL ASSESSMENT GROUPOn the basis of the answers to the initial questionnaire, two subgroups were selected for further study. Questions 1, 5, 6, 9, 10, and 11 (essentially about snoring and other symptoms of sleep and breathing disorders; see appendix) were given a weighting based on their ability to predict the presence of sleep and breathing disorders in a previous study from this department.7 The overall score was then used to rank the children in order of the likelihood of them having a sleep and breathing disorder. The 66 highest ranking children (henceforth the high risk group) and an equal number of sex matched children from the lowest rankings (henceforth the control group) were ...

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