To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma.
Patients and Methods
We examined data for 194 children (age 4–10 yrs) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed using the Sleep-Related Breathing Disorder (SRBD) questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the SRBD by removing the 6 attention/hyperactivity items. A sleep score of >.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI) which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores.
The majority of children (mean age 8.2 yrs) were male (56%), African American (66%), and insured by Medicaid (73%). Overall, 33% of children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared to children without SDB on total BPI (13.7 vs 8.8, p<.001), externalizing (9.4 vs 6.3, p<.001), internalizing (4.4 vs 2.5, p<.001), anxious/depressed (2.4 vs 1.3, p<.001), headstrong (3.2 vs 2.1, p<.001), antisocial (2.3 vs 1.7, p=.013), hyperactive (3.0 vs 1.8, p<.001), peer conflict (.74 vs .43, p=.011), and immature (2.0 vs 1.5, p=.001). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI, externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SBD subscales (snoring, sleepiness).
We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from further intervention.