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The objective of this study was to examine whether daytime sleepiness was associated with these emotional\/behavioral problems, independent of nighttime sleep-disordered breathing, or the duration of sleep. Caregivers of individuals with PWS (aged 3 to 25\u00a0years) completed the Pediatric Sleep Questionnaire (PSQ), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and the parent version of the Developmental Behavior Checklist (DBC-P). Sleep adequacy was adjusted for age by computing sleep duration against age-specific recommendations. The associations between ESS-CHAD and the total DBC and its subscale scores were evaluated by linear regression, adjusted for sleep-related breathing difficulties, sleep adequacy, and body mass index (BMI). There were 54 responses for individuals with PWS (including 22 males) aged 4.4\u201324.0 (mean 12.5) years. Daytime sleepiness predicted a substantial proportion of the variance in total DBC-P scores in the unadjusted model (28%; <jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.028; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and when adjusted for sleep adequacy, BMI, and sleep-related breathing difficulties (29%; <jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.023; <jats:italic>p<\/jats:italic>\u2009=\u20090.007). This relationship was not moderated by BMI <jats:italic>Z<\/jats:italic>-scores, but the relationship was more prominent for children younger than 12\u00a0years than for children older than 12\u00a0years.<\/jats:p><jats:p><jats:italic>Conclusions<\/jats:italic>: These findings provide preliminary novel evidence that daytime sleepiness may drive the expression of emotional\/behavioral disturbances, and should be explored as a potential modifiable risk factor for these disturbances in PWS, particularly pre-adolescent children.<\/jats:p><jats:p><jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 Individuals with Prader-Willi syndrome (PWS) commonly experience excessive daytime sleepiness and exhibit emotional\/behavioral disturbances.<\/jats:italic><jats:italic>\u2022 In the typically developing population, sleepiness is associated with emotional\/behavioral disturbances, independently of sleep-disordered breathing.<\/jats:italic>.<\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 This study found evidence for a direct link between daytime sleepiness and emotional\/behavioral disturbances, independent of sleep-related breathing difficulties, sleep adequacy, and body mass index.<\/jats:italic><jats:italic>\u2022 Excessive daytime sleepiness may be a modifiable risk factor for emotional\/behavioral disturbances in PWS.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-022-04439-2","type":"journal-article","created":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T10:03:07Z","timestamp":1647943387000},"page":"2491-2500","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Daytime sleepiness and emotional and behavioral disturbances in Prader-Willi syndrome"],"prefix":"10.1007","volume":"181","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-271X","authenticated-orcid":false,"given":"Catherine S.","family":"Choong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4944-7754","authenticated-orcid":false,"given":"Gillian M.","family":"Nixon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5824-9402","authenticated-orcid":false,"given":"A. 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The study was approved by the Western Australian Child and Adolescent Health Service Human Research Ethics Committee (RGS1112) at Perth Children\u2019s Hospital under the National Mutual Agreement, with local governance approval from all participating sites (Monash Health RES-18\u20130000-774X; Women\u2019s and Children\u2019s Health Network HREC\/18\/OTHER\/094, SSA\/18\/WCHN\/184; Queensland Children\u2019s Hospital SSA\/19\/QCHQ\/4919; La Trobe University WACAHealthServiceRGS1112; Royal Children\u2019s Hospital 2019.096; Sydney Children\u2019s Hospital Randwick 2019\/STE04456; Westmead Children\u2019s Hospital 2019\/STE04455; John Hunter Children\u2019s Hospital 2019\/STE04457; Canberra Children\u2019s Hospital 2019\/STE\/00099).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}