Parent-Reported Symptoms of Sleep-Disordered Breathing Are Associated With Increased Behavioral Problems at 2 Years of Age: The Canadian Healthy Infant Longitudinal Development Birth Cohort Study

Sukhpreet K Tamana; Lisa Smithson; Amanda Lau; Jennifer Mariasine; Rochelle Young; Joyce Chikuma; Diana L Lefebvre; Padmaja Subbarao; Allan B Becker; Stuart E Turvey; Malcolm R Sears; CHILD Study Investigators; Jacqueline Pei; Piush J Mandhane

doi:10.1093/sleep/zsx177

Parent-Reported Symptoms of Sleep-Disordered Breathing Are Associated With Increased Behavioral Problems at 2 Years of Age: The Canadian Healthy Infant Longitudinal Development Birth Cohort Study

Sleep. 2018 Jan 1;41(1):zsx177. doi: 10.1093/sleep/zsx177.

Affiliations

¹ Department of Pediatrics, University of Alberta, Edmonton, Canada.
² Educational Psychology, University of Alberta, Edmonton, Canada.
³ Sleep Medicine, Alberta Health Services, Edmonton, Canada.
⁴ Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada.
⁵ Department of Pediatrics, University of Toronto, Toronto, Canada.
⁶ Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.
⁷ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba.
⁸ Department of Pediatrics, University of British Columbia, Vancouver, Canada.

Abstract

Study objectives: To examine the association between the age of onset and duration of parent-reported symptoms of sleep-disordered breathing (SDB) and behavioral problems at age 2.

Methods: Parent-reported SDB symptoms were assessed quarterly between 3 months and 2 years among 583 Canadian Healthy Infant Longitudinal Development Edmonton-site participants. Parent-reported SDB symptoms were clustered into phenotypes using group-based trajectory analysis based on age of onset and duration of symptoms. Home-based polysomnography (PSG) was completed at 1 year. The Child Behavior Checklist preschool-version (Mean T-score 50, standard deviation 10 points) assessed total, externalizing (attention), and internalizing (anxiety, depression) behaviors at 2 years.

Results: Four phenotypes were identified: no SDB (64.7%), early-onset SDB (15.7%, peak symptoms at 9 months), late-onset (14.2%, peak symptoms at 18 months), and persistent SDB symptoms (5.3%, peak symptoms from 3 through 24 months). Persistent SDB (9.5 points, 95% CI 1.7, 17.2; p = .02) predicted the greatest magnitude of effect of total behavior problems, compared with children without SDB. Children with early-onset SDB (3.5 points, 95% CI 1.6, 5.4; p ≤ .001) and late-onset SDB (6.1 points 95% CI 4.0, 8.3; p ≤ .001) had increased total behavioral problems than children without SDB to 2 years. Additional analyses showed that the SDB phenotypes' trajectories were important for internalizing but not for externalizing behavior problems. There were no significant associations between home-PSG and parent-reported behavior problems.

Conclusions: Findings suggest that the age of onset and duration of parent-reported SDB symptoms prior to age 2 have adverse consequences for overall behavior problems.

Keywords: behavior; epidemiology; infants; population-based birth cohort; sleep apnea; sleep-disordered breathing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age of Onset
Canada / epidemiology
Child
Child Behavior Disorders / epidemiology*
Child, Preschool
Cohort Studies
Female
Humans
Infant
Longitudinal Studies
Male
Parents
Polysomnography
Pregnancy
Problem Behavior / psychology*
Sleep / physiology*
Sleep Apnea Syndromes / epidemiology*
Surveys and Questionnaires

Grants and funding

CIHR/Canada