{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:12:40Z","timestamp":1789179160529,"version":"build-2803163510"},"reference-count":48,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,3,1]]},"abstract":"<jats:p>Objectives. This study examined the hypothesis that domains of neurobehavioral function would be selectively affected by sleep-disordered breathing (SDB). Therefore, we assessed potential relationships between objectively measured sleep disturbances and neurobehavioral function in children with reported symptoms of attention-deficit\/hyperactivity disorder (ADHD) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in the local community and potential relationships to parental snoring and passive smoking.<\/jats:p>\n               <jats:p>Methods. Parents of 5- to 7-year-old children in public schools were surveyed about their child\u2019s sleeping habits using a validated questionnaire. The questionnaire also asked whether they believed their child to be hyperactive or have ADHD. Children with reported symptoms of ADHD and control children were randomly selected and invited to the Sleep Medicine Center for an overnight polysomnographic assessment and a battery of neurocognitive tests.<\/jats:p>\n               <jats:p>Results. The questionnaire response rate was 47.6% (n = 5728). Frequent and loud snoring was reported for 673 children (11.7%). Similarly, 418 (7.3%) children were reported to have hyperactivity\/ADHD, 313 (76.5%) of which were boys. Eighty-three children with parentally reported symptoms of ADHD were invited for full evaluation at the Sleep Medicine Center together with 34 control children. After assessment with the Conners\u2019 Parent Rating Scale, 44 children were designated as having \u201csignificant\u201d symptoms of ADHD, 27 as \u201cmild,\u201d and 39 designated as \u201cnone\u201d (controls). Overnight polysomnography indicated that obstructive sleep apnea was present in 5% of those with significant ADHD symptoms, 26% of those with mild symptoms, and 5% of those with no symptoms. In the cohort, no sleep variable accounted for more than a negligible proportion of the variance in domains of neurobehavioral function.<\/jats:p>\n               <jats:p>Conclusions.\u2003An unusually high prevalence of snoring was identified among a group of children designated as showing mild symptoms of ADHD based on the Conners\u2019 ADHD index identified from a community sample. However, whereas SDB is not more likely to occur among children with significant ADHD symptoms, it is significantly highly prevalent among children with mild hyperactive behaviors. Sleep studies further revealed that rapid eye movement disturbances are more likely to occur in children with significant symptoms, and they seem to impose significant but mild effects on daytime neurobehavioral functioning. We conclude that in children with significant symptoms of ADHD, the prevalence of SDB is not different from that of the general pediatric population and that rapid eye movement sleep in these children is disturbed and may contribute to the severity of their behavioral manifestations. Furthermore, SDB can lead to mild ADHD-like behaviors that can be readily misperceived and potentially delay the diagnosis and appropriate treatment.<\/jats:p>","DOI":"10.1542\/peds.111.3.554","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"554-563","source":"Crossref","is-referenced-by-count":395,"title":["Sleep and Neurobehavioral Characteristics of 5- to 7-Year-Old Children With Parentally Reported Symptoms of Attention-Deficit\/Hyperactivity Disorder"],"prefix":"10.1542","volume":"111","author":[{"given":"Louise M.","family":"O\u2019Brien","sequence":"first","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl R.","family":"Holbrook","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn B.","family":"Mervis","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie J.","family":"Klaus","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Bruner","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy J.","family":"Raffield","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Rutherford","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rochelle C.","family":"Mehl","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Wang","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Tuell","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany C.","family":"Hume","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gozal","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2003,3,1]]},"reference":[{"key":"2021121104554934600_R1","unstructured":"American Psychiatric Association. 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Pediatr Pulmonol.1992;13:239\u2013244","DOI":"10.1002\/ppul.1950130412"},{"key":"2021121104554934600_R5","doi-asserted-by":"crossref","unstructured":"Barkley RA. Attention-Deficit Disorder: A Handbook for Diagnosis and Treatment. New York, NY: Guilford Press; 1990:1\u2013147","DOI":"10.1007\/978-1-4615-7142-1_6"},{"key":"2021121104554934600_R6","doi-asserted-by":"crossref","unstructured":"Brown RT, Freeman WS, Perrin JM, et al. Prevalence and assessment of attention-deficit\/hyperactivity disorder in primary care settings. Pediatrics.2001;107(3). Available at: www.pediatrics.org\/cgi\/content\/full\/107\/3\/e43","DOI":"10.1542\/peds.107.3.e43"},{"key":"2021121104554934600_R7","unstructured":"National Institutes of Health. Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder. Washington, DC: US Government Printing Office; NIH Consensus Statement; 1998"},{"key":"2021121104554934600_R8","doi-asserted-by":"crossref","unstructured":"Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull.1997;121:65\u201394","DOI":"10.1037\/0033-2909.121.1.65"},{"key":"2021121104554934600_R9","doi-asserted-by":"crossref","unstructured":"Ali NJ, Pitson D, Stradling JR. Snoring, sleep disturbance and behaviour in 4\u20135 year olds. Arch Dis Child.1993;68:360\u2013366","DOI":"10.1136\/adc.68.3.360"},{"key":"2021121104554934600_R10","doi-asserted-by":"crossref","unstructured":"Corkum P, Tannock R, Moldofsky H. Sleep disturbance in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry.1998;37:637\u2013646","DOI":"10.1097\/00004583-199806000-00014"},{"key":"2021121104554934600_R11","doi-asserted-by":"crossref","unstructured":"Owens, J, Maxim R, Nobile C, McGuinn M, Msall M. Parental and self-report of sleep in children with attention deficit\/hyperactivity disorder. 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EEG arousals: scoring and rules and examples. Sleep.1992;15:173\u2013184","DOI":"10.1093\/sleep\/15.2.173"},{"key":"2021121104554934600_R26","doi-asserted-by":"crossref","unstructured":"American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med.1996;153:866\u2013878","DOI":"10.1164\/ajrccm.153.2.8564147"},{"key":"2021121104554934600_R27","doi-asserted-by":"crossref","unstructured":"Marcus CL, Omlin KJ, Basinski DJ, et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis.1992;156:1235\u20131239","DOI":"10.1164\/ajrccm\/146.5_Pt_1.1235"},{"key":"2021121104554934600_R28","unstructured":"Diagnostic Classification Steering Committee. Periodic limb movement disorder. In: International Classification of Sleep Disorders: Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorders Association; 1990:69\u201371"},{"key":"2021121104554934600_R29","doi-asserted-by":"crossref","unstructured":"Conners CK. Conners\u2019 Rating Scales\u2014Revised. North Tonawanda, NY: Multi-Health Systems Publishing; 1997","DOI":"10.1037\/t81067-000"},{"key":"2021121104554934600_R30","unstructured":"Achenbach TM. Manual for the Revised Child Behavior Checklist. Burlington, VT: University of Vermont, Department of Psychiatry; 1991"},{"key":"2021121104554934600_R31","unstructured":"Elliott CD. Differential Ability Scales: Handbook. San Antonio, TX: Harcourt Brace Jovanovich; 1990"},{"key":"2021121104554934600_R32","unstructured":"Korkman M, Kirk U, Kemp S. A Developmental Neuropsychological Assessment. San Antonio, TX: Harcourt Brace Jovanovich; 1998"},{"key":"2021121104554934600_R33","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit\/hyperactivity disorder. Pediatrics.2000;105:1158\u20131170","DOI":"10.1542\/peds.105.5.1158"},{"key":"2021121104554934600_R34","doi-asserted-by":"crossref","unstructured":"Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med.1999;159:1527\u20131532","DOI":"10.1164\/ajrccm.159.5.9809079"},{"key":"2021121104554934600_R35","doi-asserted-by":"crossref","unstructured":"Corbo GM, Fuciarelli F, Foresi A, De Benedetto F. Snoring in children: association with respiratory symptoms and passive smoking. BMJ.1989;299:1491\u20131494","DOI":"10.1136\/bmj.299.6714.1491"},{"key":"2021121104554934600_R36","doi-asserted-by":"crossref","unstructured":"Forastiere F, Corbo GM, Michelozzi P, et al. 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