To examine the association between the age of onset and duration of parent-reported symptoms of sleep disordered breathing (SDB) and behavioral problems at age two years.
Parent-reported SDB symptoms were assessed quarterly between three months and two years among 583 Canadian Healthy Infant Longitudinal Development (CHILD) Edmonton-site participants. Parent-reported SDB symptoms were clustered into phenotypes using group-based trajectory analysis based on age of onset and duration of symptoms. Home-based polysomnography (PSG) was completed at one year. The Child Behavior Checklist (CBCL) preschool-version (Mean T-score 50, standard deviation 10 points) assessed total, externalizing (attention), and internalizing (anxiety, depression) behaviors at two years.
Four phenotypes were identified: no SDB (64.7%), early-onset SDB (15.7%, peak symptoms at 9 months), late-onset (14.2%, peak symptoms at 18 months), and persistent SDB symptoms (5.3%, peak symptoms from 3 through 24 months). Persistent SDB (9.5 points, 95%CI 1.7, 17.2; p=0.02) predicted the greatest magnitude of effect of total behavior problems, compared to children without SDB. Children with early-onset SDB (3.5 points, 95%CI 1.6, 5.4; p≤0.001) and late-onset SDB (6.1 points 95%CI 4.0, 8.3; p≤0.001) had increased total behavioral problems than children without SDB to two years. Additional analyses showed that the SDB phenotypes trajectories were important for internalizing but not for externalizing behavior problems. There were no significant associations between home-PSG and parent-reported behavior problems.
Findings suggest that the age of onset and duration of parent-reported SDB symptoms prior to age two years has adverse consequences for overall behavior problems.