Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements.

STUDY OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) has shown associations with restless legs syndrome (RLS) and periodic leg movements during sleep (PLMS) among small samples of referred children, but whether RLS or PLMS are common more generally among hyperactive children has not been well studied. DESIGN: Cross-sectional survey. SETTING: Two university-affiliated but community-based general pediatrics clinics. PATIENTS: N=866 children (469 boys), aged 2.0 to 13.9 years (mean 6.8+/-3.2 years), with clinic appointments. INTERVENTIONS: N/A. MEASUREMENTS: A validated Pediatric Sleep Questionnaire assessed for PLMS (a 6-item subscale), restless legs, growing pains, and several potential confounds of an association between behavior and PLMS or RLS. Parents also completed two common behavioral measures, a DSM-IV-derived inattention/hyperactivity scale (IHS) and the hyperactivity index (HI, expressed as a t-score) of the Conners' Parent Rating Scale. RESULTS: Restless legs were reported in 17% (95% C.I. [15, 20]) of the subjects. Positive HI scores (>60) were found in 13% [11, 16] of all subjects, 18% [12, 25] of children with restless legs, and 11% [9, 14] of children without restless legs (chi-square p<0.05). Odds ratios between HI>60 and each of the following were: a one-s.d. increase in the overall PLMS score, 1.6 [1.4, 1.9]; restless legs, 1.9 [1.1, 3.2]; and growing pains, 1.9 [0.9, 3.6] (all age and sex-adjusted). Results were similar for high IHS scores (>1.25). The associations between each behavioral measure and the PLMS score retained significance after statistical adjustment for sleepiness, snoring, restless sleep in general, or stimulant use. CONCLUSIONS: Inattention and hyperactivity among general pediatric patients are associated with symptoms of PLMS and RLS. If either condition contributes to hyperactivity, the magnitude of association suggests an important public health problem.

Symptoms of sleep disturbances among children at two general pediatric clinics.

OBJECTIVE: We assessed the frequency of childhood sleep problems at 2 general pediatric clinics. STUDY DESIGN: Parents of 1038 unselected children (554 boys) aged 2.0 to 13.9 years completed a validated Pediatric Sleep Questionnaire while waiting for appointments. RESULTS: Habitual snoring was reported in 176 (17%) of the children. Criterion scores suggestive of sleep-disordered breathing were found in 115 (11%) of the children, in 29% of children at the clinic for neurologic indications, and in 21% of children at the clinic for noninfectious respiratory indications. Insomnia (ie, unrefreshing sleep or difficulty with sleep onset, sleep maintenance, or early morning awakening from sleep) was reported in 430 (41%) of the children; > or =2 symptoms were present in 191 (18%) of the children. Excessive daytime sleepiness was suggested in 148 (14%) of the children, and 390 (38%) had symptoms of sleep terrors, sleepwalking, or nocturnal bruxism. CONCLUSIONS: Sleep problems such as sleep-disordered breathing, insomnia, excessive sleepiness, and parasomnias are frequent among children seen at general pediatric practices.

Inattention, hyperactivity, and symptoms of sleep-disordered breathing.

OBJECTIVE: Inattention and hyperactivity are frequent among children with sleep-disordered breathing (SDB) and often improve when SDB is treated. However, the frequency of SDB symptoms among inattentive and hyperactive children has received little study. DESIGN: Cross-sectional survey. SETTING: Two university-affiliated but community-based general pediatrics clinics. PATIENTS: Patients consisted of N = 866 children (469 boys), aged 2.0 to 13.9 years (mean: 6.8 plus minus 3.2 years), with clinic appointments. MEASURES: A validated Pediatric Sleep Questionnaire assessed for habitual snoring (1 item), snoring severity (a 4-item subscale), sleepiness (4 items), and overall risk of SDB (16 items). Parents also completed 2 common behavioral measures, an inattention/hyperactivity scale (IHS) derived from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the hyperactivity index (HI, expressed as a t score) of the Conners' Parent Rating Scale. RESULTS: Habitual snoring was reported in 16% (95% confidence interval [CI]: 13, 19) of the participants. High HI scores (>60) were found in 13% (95% CI: 11, 16) of all participants, 22% (95% CI: 15, 29) of habitual snorers, and 12% (95% CI: 9, 14) of nonsnorers. Odds ratios between HI >60 and each of the following were: habitual snoring, 2.2 (95% CI: 1.4, 3.6); 1 additional positive symptom-item on the snoring scale, 1.3 (95% CI: 1.1, 1.5); 1 additional positive item on the sleepiness scale, 1.6 (95% CI: 1.4, 2.0); and a 1-standard deviation increase in the overall SDB score, 1.7 (95% CI: 1.4, 2.0; all odds ratios age- and sex-adjusted). Results were similar for high IHS scores (>1.25). Stratification by age and sex showed that most of the association with snoring (but not sleepiness) derived from boys <8 years old. CONCLUSIONS: Inattention and hyperactivity among general pediatric patients are associated with increased daytime sleepiness and---especially in young boys---snoring and other symptoms of SDB. If sleepiness and SDB do influence daytime behavior, the current results suggest a major public health impact.