Conduct problems and symptoms of sleep disorders in children

Objective: Conduct problems and hyperactivity are frequent among children referred for sleep-disordered breathing (SDB), restless legs syndrome, or periodic leg movements during sleep (PLMS), but children not referred to sleep centers have received little study. Method: Parents of children aged 2 to 14 years were surveyed at two general clinics between 1998 and 2000. A Pediatric Sleep Questionnaire generated validated scores for SDB and PLMS. The Conners Parent Rating Scale (CPRS-48) produced an age- and sex-adjusted Conduct Problem Index (CPI) and Hyperactivity Index. Results: Parents of about 1,400 children were approached; those of 872 (62%) completed the surveys. Bullying and other specific aggressive behaviors were generally two to three times more frequent among 114 children at high risk for SDB than among the remaining children. An association between high CPI and SDB scores (p<.0001) retained significance after adjustment for sleepiness, high Hyperactivity Index, stimulant use, or PLMS scores. Analogous results were obtained for the association between high CPI and PLMS scores. Conclusions: Conduct problems were associated with symptoms of SDB, restless legs syndrome, and PLMS. Although these results cannot prove a cause-and-effect relationship, assessment for sleep disorders may provide a new treatment opportunity for some aggressive children.