Could Sleep Disorders Lead to Aggressive Behavior in Children?

Could Sleep Disorders Lead to Aggressive Behavior in Children?
Could Sleep Disorders Lead to Aggressive Behavior in Children?

Summary
This study was performed to assess whether schoolchildren with aggressive behavior could have symptoms suggestive of sleep-disordered breathing. Both teachers and parents assessed around 341 schoolchildren on their conduct, bullying behavior and sleep-disorder-type breathing. They were rated on standard scales for each of the parameters. It was seen that those with conduct problems in school (bullying or disciplinary issues) had more symptoms suggestive of sleep-disordered breathing, when compared to more disciplined schoolchildren. These aggressive children were also found to snore more than the other children did.

Introduction
Conduct problems could include quarrels, destructive behavior and disobedience. These are common in children and tackling these can be a major challenge in schools. Approximately 2 to 9 percent of the children in the U.S. are diagnosed with a conduct disorder, with involvement in bullying. It was found that children who bully could later develop psychiatric symptoms, antisocial behavior and begin substance abuse. A possible contributor to this violent behavior could be sleep-disordered breathing. This disturbed breathing involves either habitual snoring or obstructive breathing while sleeping. Most studies relating behavior to sleep-disordered breathing were done only in those with aggressive behavior. No assessment was conducted on a broader population group. Thus, the participants of this study were from a broader group of school-aged children with and without aggressive behavior.

Methodology
* Parents of 341 children completed all the surveys associated with this study, along with the teachers in the schools. Only children in grades 2 to 5 were included in the study.
* The study included a few surveys based on demographics, a detailed pediatric sleep questionnaire, and the parent rating scale. The parents of the children completed these, while the teachers completed a teacher rating scale.
* These questionnaires assessed the conduct, aggressive behavior, and bullying tendency of the children.

Results
* Approximately 23 percent of the children snored during more than half of their sleeping hours and they appeared sleepier than those without habitual snoring did.
* About 21 percent of the 341 children had conduct problems as rated by the parents; 24 percent out of 240 children fell in this category, when rated by the teachers.
* Those with conduct problems (30 percent) seemed to have more symptoms of sleep-disordered breathing than those without conduct issues (14 percent).
* Nearly 7.6 percent of the children showed bullying behavior according to the parents, while it was 5.8 percent according to the teachers. However, the relation between bullying and sleep-disordered breathing was insignificant.

Shortcomings/Next steps
The study population was low; not more than 30 percent of the children were recruited in this study. There were inconsistencies between the reports given by the parent and the teacher. Variations were seen with both conduct behavior and bullying. Analysis of sleepiness and snoring in this study helped with the assessment of sleep-disordered breathing. However, sleepiness could occur due to many other reasons also, and this may have induced a bias in the study.

Conclusion
This study shows that schoolchildren with conduct issues have increased symptoms of sleep-disordered breathing, when compared with their peers. If sleepiness, which could be a result of sleep-disordered breathing, contributes to aggressive behavior, then the data from this study suggests that 39.5 percent of conduct problems in the population could be resolved by eliminating sleepiness. It is known that inadequate sleep in children, due to either disorders or restriction, could be associated with various behavioral impairments, including ADHD, regulation of impulsive behavior and emotional control. It is clear that most children in urban settings do not get adequate sleep. Data from this study confirms that sleepiness, whether or not influenced by sleep-disordered breathing, plays an important role in aggressive behavior. Thus, tackling childhood sleepiness could reduce aggressive behavior in children.

For More Information:
Aggressive Behavior, Bullying, Snoring, and Sleepiness in Schoolchildren
Publication Journal: Sleep Medicine, 2011
By Louise M O’Brien, Neali H Lucas; University of Michigan, Ann Arbor

*FYI Living Lab Reports Are Summaries of the Original Research.



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