Due to adverse social and environmental factors, Black children and/or those living in lower socioeconomic status (SES) contexts are more likely to experience sleep disorders, including obstructive sleep apnea syndrome (OSAS), as well as short and irregular sleep duration. Children with OSAS also often have behavioral difficulties, but little is known about whether these challenges are worse when children also experience poor sleep, which is linked to similar child outcomes. Understanding sleep patterns, potential disparities, and linkages with child outcomes among children with OSAS can inform comprehensive and equitable treatment strategies.
In a sample of children diagnosed with OSAS, we looked at whether there were differences in child sleep patterns by race, ethnicity, and SES, as well as whether poor sleep was associated with worse child behavior. The specific sleep patterns we examined were short sleep duration, sleeping less than national age-based guidelines, and sleep duration variability, or how consistent the child’s sleep duration was during the week. Child outcomes included teacher and caregiver-rated questionnaires about child attention and behavior.
We used baseline data from children ages 5 to 9.9 years enrolled in the Childhood Adenotonsillectomy Trial (CHAT). CHAT was a multi-site randomized trial comparing the efficacy of early adenotonsillectomy to watchful waiting with supportive care in treating child OSAS. Nighttime sleep duration and variability were measured using 5-night sleep diaries. We calculated nighttime sleep duration variability at the within-child level using robust regression models to generate standard errors representing average variation for each child.
Compared to White children with OSAS, Black children with OSAS experienced shorter nighttime sleep duration, by about 25 minutes, and more variable nightly sleep duration. Having a lower versus higher family income was also linked to shorter sleep duration. Caregivers reported more attention and behavioral problems for children with OSAS who experienced shorter and more variable nighttime sleep. Teachers rated children with OSAS who had variable sleep timing as having worse executive functioning skills.
Having a short and/or more variable sleep duration could exacerbate the attention and behavioral difficulties found in children with OSAS. Clinicians should consider addressing sleep health when treating OSAS in children. There is also a need for equitable interventions to address sleep health disparities and promote healthy sleep among children with OSAS.
Guest Blogger: Ariel A. Williamson, PhD
Paper Authors: Ariel A. Williamson, PhD,1,2 Jiaxin Fan, PhD,2 Laura Distel, PhD,3,4 Rui Xiao, PhD,1,2 Darko Stefanovski, PhD,5 & Ignacio E. Tapia, MD1,2*
1 Children’s Hospital of Philadelphia, Philadelphia, PA 2 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 3 Boston Children’s Hospital, Boston, MA 4 Harvard Medical School, Harvard University, Boston, MA 5 Veterinary School of Medicine, University of Pennsylvania, Philadelphia, PA * Ignacio E. Tapia is now at the University of Miami Miller School of Medicine, Miami, FL