Sleep habits and neurobehavioural correlates in young children who snore

Background: children with sleep disordered breathing have fragmented sleep, but less is known about other sleep behaviours and their association with neurocognitive function.Method: snoring children listed for adenoidectomy and/or tonsillectomy were studied with non-snoring controls. SDB was assessed by polysomnography (PSG). Parents completed the Children’s Sleep Habits Questionnaire (CHSQ), Behavior Rating Inventory of Executive Function (BRIEF) and Strengths and Difficulties Questionnaire (SDQ). Objective neuropsychological assessment included the NEPSY visual attention measure (VA)Results: sixty-eight snoring children, mean age 4.6 years (SD 1.2), 59% boys, and 39 controls, 4.9 years (SD 1.2), 54% boys, were recruited. Snoring children had higher CSHQ subscale scores: bedtime resistance (Po0.000); sleep onset delay (Po0.01); sleep duration (Po0.000); sleep anxieties (Po0.002); night waking (Po0.000); parasomnias (Po0.000) and daytime sleepiness (Po0.000). However, CSHQ subscales did not correlate with apnoea/hypopnoea index, mean or min. SpO2 in snoring children. Snorers had significantly worse BRIEF subscale T-scores and emotional, hyperactivity and peer problems (SDQ sub-scales) compared to non-snoring children. BRIEF global executive composite correlated with all CSHQ subscales and SDQ total score correlated with all but the sleep anxieties CHSQ subscale. However, neither of these parental assessments correlated with PSG respiratory measures. NEPSY VA was better in controls (P50.03) but did not correlate with objective or subjective sleep measures.Conclusion: parents report diverse sleep problems and neurobehavioural difficulties in young snoring children compared to controls. These parental reports show a high degree of correlation. However, PSG measures fail to correlate with parent reports of sleep problems or neurobehavioural function. This may represent parental reporting bias or temporal dissociation between the origins of neurobehavioural impairment and PSG. Preliminary post-operative assessment of snorers indicates improvement in CSHQ and SDQ sub-scales but persistent executive function difficulties. In support of parent reports, NEPSY VA measures improve in the snoring group with a significant group by time interaction (F (1.53)54.35, P50.42