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Nonetheless, frequency, severity, and consequences of sleep problems are still unclear. The Fragile X Online Registry with Accessible Research Database (FORWARD\u2010\n                    <jats:italic>version<\/jats:italic>\n                    \u20103), including Clinician Report and Parent Report forms, was analyzed for frequency, severity, relationship with behavioral problems, and impact of sleep difficulties in a mainly pediatric cohort. A focused evaluation of sleep apnea was also conducted. Six surveyed sleep difficulties were moderately frequent (~23%\u201346%), relatively mild, affected predominantly younger males, and considered a problem for 7%\u201320% of families. Snoring was more prevalent in older individuals. All sleep difficulties were associated with irritability\/aggression and most also to hyperactivity. Only severe snoring was correlated with sleep apnea (loud snoring: 30%; sleep apnea: 2%\u20133%). Sleep difficulties are prevalent in children with FXS and, although they tend to be mild, they are associated with behavioral problems and negative impact to families. Because of its cross\u2010sectional nature, clinic\u2010origin, use of ad hoc data collection forms, and lack of treatment data, the present study should be considered foundational for future research aiming at better recognition and management of sleep problems in FXS.\n                  <\/jats:p>","DOI":"10.1002\/ajmg.a.62601","type":"journal-article","created":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T07:47:44Z","timestamp":1639122464000},"page":"1029-1039","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Sleep problems in fragile X syndrome: Cross\u2010sectional analysis of a large clinic\u2010based cohort"],"prefix":"10.1002","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7263-5134","authenticated-orcid":false,"given":"Dejan B.","family":"Budimirovic","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Fragile X Clinic Kennedy Krieger Institute, JHMI  Baltimore Maryland USA"},{"name":"Department of Psychiatry and Behavioral Sciences\u2010Child Psychiatry Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2137-5405","authenticated-orcid":false,"given":"Dragana D.","family":"Protic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8422-8568","authenticated-orcid":false,"given":"Carol M.","family":"Delahunty","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Cleveland Clinic Children's Hospital  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7726-0551","authenticated-orcid":false,"given":"Howard F.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and Biostatistics Columbia University, Irving Medical Center  , New York New York USA"},{"name":"Department of Psychiatry, Mental Health Data Science Columbia University Medical Center and NY State Psychiatric Institute  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5068-9799","authenticated-orcid":false,"given":"Tse\u2010Hwei","family":"Choo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Mental Health Data Science Columbia University Medical Center and NY State Psychiatric Institute  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Mental Health Data Science Columbia University Medical Center and NY State Psychiatric Institute  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7099-1522","authenticated-orcid":false,"given":"Elizabeth","family":"Berry\u2010Kravis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Rush University Medical Center  Chicago Illinois USA"},{"name":"Department of Neurological Sciences Rush University Medical Center  Chicago Illinois USA"},{"name":"Department of Biochemistry Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8561-8453","authenticated-orcid":false,"given":"Walter E.","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Department of Human Genetics Emory University School of Medicine  Atlanta Georgia USA"},{"name":"Department of Neurology Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the FORWARD Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13229-021-00426-w"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0028204"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.23641"},{"key":"e_1_2_10_5_1","unstructured":"Budimirovic B. 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