Arman A R, Ersu R, Save D, Karadag B, Karaman G, Karabekiroglu K, Karakoc F, Dagli E, Berkem M
Marmara University Child Psychiatry Department, Marmara University, Altunizade, Istanbul, Turkey.
Child Care Health Dev. 2005 Nov;31(6):707-17. doi: 10.1111/j.1365-2214.2005.00561.x.
Neurobehavioural symptoms of inattention and hyperactivity are common in children with sleep-disordered breathing (SDB). Prevalence rates of habitual snoring and attention deficit hyperactivity disorder (ADHD) are very similar and both have a substantial negative effect on children's behavioural health.
We examined the differences for subjective attentional and hyperactivity measures reported by parents and teachers among primary school children with habitual snoring and age- and sex-matched controls in a community-based case-control study in Istanbul. Methods In 2002, a survey was carried out to determine the prevalence of snoring in 2147 primary school children. After one year, in 2003, 151 children with habitual snoring and 302 controls from this survey were studied with parental SDB questionnaire, Conners' Parent (Conners-P) and Teacher Scales, and an inattention hyperactivity scale (IHS). Exclusion criteria included history of ADHD diagnosis, controls who started to snore and habitual snorers (HS) who no longer snored in this follow-up study.
Ninety-six HS and 190 control subjects (mean age: 9.4 +/- 1.3) were evaluated. HS had significantly more symptoms of hyperactivity (Conners-ADHD index) (P: 0.033), attentional (P: 0.019), and conduct and oppositional defiant in subscales (P: 0.001) of Conners-P and IHS-Parents. A pooled score of Conners-P ADHD Index > 60 and IHS-Parent score > 1.25 showed considerable difference in HS when compared with controls (5.1% vs. 1.4%) (P < 0.0001). Daytime hyperactivity and excessive daytime sleepiness reported by parents correlated with scores of Conners-P and IHS-P (P < 0.01). Teachers' observations showed significant correlations with learning disability and the level of academic performance in HS (P < 0.01). Other behavioural parameters related to SDB were not significantly correlated with teachers' ADHD ratings in HS.
Increased rates of moderate hyperactivity as well as conduct and oppositional defiant symptoms in HS reported by the parents might reflect a negative impact on overall neurobehavioural health. The teachers' scores yielded no significant results among HS and controls. This may be caused by the limitation due to shared method variance. The negative effect of crowded classes on teachers' evaluations must be also taken into consideration. After exclusion of a diagnosis of ADHD in children presenting with hyperactivity and inattention, children with habitual snoring with prominent scores of behavioural measures should be considered as candidates for further assessment by a sleep specialist.
注意力不集中和多动等神经行为症状在睡眠呼吸障碍（SDB）儿童中很常见。习惯性打鼾和注意力缺陷多动障碍（ADHD）的患病率非常相似，且两者都对儿童的行为健康产生重大负面影响。
在伊斯坦布尔进行的一项基于社区的病例对照研究中，我们比较了习惯性打鼾的小学生及其年龄和性别匹配的对照组的父母和教师报告的主观注意力和多动测量指标的差异。方法：2002年，对2147名小学生进行了一项调查以确定打鼾的患病率。一年后的2003年，对该调查中的151名习惯性打鼾儿童和302名对照儿童进行了研究，使用了父母SDB问卷、康纳斯父母量表（Conners-P）、教师量表以及注意力不集中多动量表（IHS）。排除标准包括ADHD诊断史、在本次随访研究中开始打鼾的对照儿童以及不再打鼾的习惯性打鼾者（HS）。
对96名HS和190名对照受试者（平均年龄：9.4±1.3）进行了评估。HS在康纳斯-ADHD指数（P：0.033）、注意力方面（P：0.019）以及康纳斯-P和IHS-父母量表的分量表中的品行和对立违抗方面（P：0.001）有明显更多的症状。康纳斯-P ADHD指数>60且IHS-父母得分>1.25的综合得分显示，与对照组相比，HS有显著差异（5.1%对1.4%）（P<0.0001）。父母报告的白天多动和白天过度嗜睡与康纳斯-P和IHS-P得分相关（P<0.01）。教师的观察结果显示与HS的学习障碍和学业成绩水平有显著相关性（P<0.01）。与SDB相关的其他行为参数与HS教师的ADHD评分无显著相关性。
父母报告的HS中中度多动以及品行和对立违抗症状的增加可能反映了对整体神经行为健康的负面影响。教师的评分在HS和对照组之间未得出显著结果。这可能是由于共同方法方差导致的局限性。还必须考虑拥挤的班级对教师评估的负面影响。在排除患有多动和注意力不集中的儿童的ADHD诊断后，行为测量得分突出的习惯性打鼾儿童应被视为由睡眠专家进行进一步评估的候选对象。
