{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:46:23Z","timestamp":1783485983475,"version":"3.55.0"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,10,1]]},"abstract":"<jats:p>Objectives. Sleep-disordered breathing is associated with impaired behavior and poor academic performance in children. We aimed to determine the extent of behavioral problems in snoring children, clarify the role of intermittent hypoxia, and test the reversibility of impaired behavior and poor academic performance.<\/jats:p>\n               <jats:p>Methods. In 1144 children, habitual snoring (HS; snoring frequently or always) and impaired behavior were assessed using parental questionnaires. Intermittent hypoxia (ie, presence of \u22655 arterial oxygen desaturations by \u22654% or \u22651 desaturation to \u226490%) was investigated with pulse oximetry. Poor academic performance (grade 4\u20136 on a 6-point scale in mathematics, science, or spelling) was based on the last school report. HS, impaired behavior, and academic performance were reevaluated after 1 year. Adjusted odds ratios (ORs) were calculated using unconditional logistic regression.<\/jats:p>\n               <jats:p>Results. HS was significantly associated with hyperactive (OR: 2.4) and inattentive behavior (OR: 4.0), daytime tiredness (OR: 7.1), and sleepiness (OR: 2.6\u20134.8). These associations were independent of intermittent hypoxia. HS was also significantly associated with bad conduct (OR: 2.8), emotional symptoms (OR: 5.5), and peer problems (OR: 9.7). At follow-up, hyperactive and inattentive behavior but not academic success had significantly improved in children in whom HS had ceased.<\/jats:p>\n               <jats:p>Conclusions. We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.<\/jats:p>","DOI":"10.1542\/peds.2003-1145-l","type":"journal-article","created":{"date-parts":[[2004,10,13]],"date-time":"2004-10-13T18:57:26Z","timestamp":1097693846000},"page":"1041-1048","source":"Crossref","is-referenced-by-count":131,"title":["Habitual Snoring, Intermittent Hypoxia, and Impaired Behavior in Primary School Children"],"prefix":"10.1542","volume":"114","author":[{"given":"Michael S.","family":"Urschitz","sequence":"first","affiliation":[{"name":"Department of Neonatology, University Children\u2019s Hospital, Tuebingen, Germany"},{"name":"Division of Neonatology, Department of Pediatrics, Vienna General Hospital, University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Eitner","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke","family":"Guenther","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Eggebrecht","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Wolff","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar M.","family":"Urschitz-Duprat","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Schlaud","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian F.","family":"Poets","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Children\u2019s Hospital, Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2004,10,1]]},"reference":[{"key":"2021120906073091900_R1","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics. 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Ha\u0308ufigkeit von OSAS-symptomen im kleinkindesalter\u2014vorstudie, multizenterstudie der AG Pa\u0308diatrie DGSM [Frequency of OSAS symptoms in early childhood\u2014pilot study, multicenter study of the Pediatric Task Force of DGSM]. Somnologie.\u20081999;3:313\u2013318","DOI":"10.1007\/s11818-999-0041-4"},{"key":"2021120906073091900_R21","doi-asserted-by":"crossref","unstructured":"Urschitz MS, Wolff J, Von Einem V, Urschitz-Duprat PM, Schlaud M, Poets CF. Reference values for nocturnal home pulse oximetry during sleep in primary school children. Chest.\u20082003;123:96\u2013101","DOI":"10.1378\/chest.123.1.96"},{"key":"2021120906073091900_R22","doi-asserted-by":"crossref","unstructured":"Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. 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