child in_bedChildren with sleep-related breathing problems, such as snoring or apnea, frequently have concurrent behavioral sleep problems, such as waking repeatedly, and vice versa, according to a study conducted at the Albert Einstein College of Medicine of Yeshiva University.

Researchers analyzed data on more than 11,000 children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom. Using a mailed questionnaire, parents reported their child’s snoring and apnea at 18, 30, 42, and 57 months of age. Questions included whether their child refused to go to bed, whether they regularly woke early, had difficulty sleeping, had nightmares, got up after being put to bed, woke in the night, or awakened after a few hours. Children with five or more of these behaviors simultaneously were considered to have a behavioral sleep problem.

According to the study, lead by Melisa Moore, PhD, behavioral sleep problems over the 18- to 57-month age reporting period ranged from 15% to 27% with a peak at 30 months of age. Among children with behavioral sleep problems, 26% to 40% had habitual SDB, again peaking at 30 months. Among children who had habitual SDB, 25% to 37% also had a behavioral sleep problem, peaking at 30 months.

While it is unlikely that behavioral sleep problems cause SDB, the converse may be true, noted senior author Karen Bonuck, PhD. Frequent night wakings initially related to SDB may be reinforced by the parents’ anxious responses. These behaviors may, in turn, develop into a persistent behavioral sleep problem, despite adequate treatment for SDB.

“Our findings should raise awareness among parents and physicians that if a child is sleeping poorly, they should delve deeper to see if there is an unrecognized respiratory-related sleep problem,” said Bonuck, professor of family and social medicine and of obstetrics & gynecology and women’s health at Einstein. “The best way to make sure this happens is by taking an interdisciplinary approach to the care of these children.”

The study appears in the December 4 online edition of Behavioral Sleep Medicine.