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Sleep Med. 2011 Feb;12(2):163-9. doi: 10.1016/j.sleep.2010.06.012. Epub 2011 Jan 14.

Behavioral sleep disturbances in children clinically referred for evaluation of obstructive sleep apnea.

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  • 1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, ML 2021, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.



Obstructive sleep apnea (OSA) and behavioral sleep disturbances (BSD) are known to have a negative health impact on children. OSA and BSD may coexist; however, such comorbidity is not fully appreciated in clinical settings.


Patients referred for OSA evaluation completed polysomnography and the Children's Sleep Habits Questionnaire. Prevalence estimates for clinically significant BSD were computed and comorbidity of BSD and OSA was examined. Chart reviews were completed to determine if BSD were addressed in the medical treatment plan.


Over one-half of the sample had a clinically significant BSD. Patients with comorbid OSA and BSD represented 39.46% of the sample. In 36-54% of the patients with a clinically significant BSD, no plan to treat the BSD was documented in the patient's medical record.


Children referred for evaluation of OSA have a high likelihood of experiencing clinically significant BSD irrespective of OSA diagnosis. Sleep medicine clinicians should be careful not to overlook the potential impact of BSD even after a child has been formally diagnosed with OSA. Physician knowledge of empirically supported behavioral sleep treatments or access to behavioral sleep medicine services is an essential component of comprehensive care for children clinically referred for OSA evaluation.

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