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Published ahead of print on May 28, 2003, doi:10.1164/rccm.200212-1397OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 4, August 2003, 464-468

A more recent version of this article appeared on August 15, 2003
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Submitted on December 8, 2002
Accepted on May 15, 2003

Snoring, intermittent hypoxia and academic performance in primary school children

Michael S Urschitz1, Anke Guenther2, Esther Eggebrecht2, Judith Wolff2, Pilar M Urschitz-Duprat2, Martin Schlaud3, and Christian F Poets4*

1 Neonatology, University Hospital of Tuebingen, Tuebingen, Germany; Pediatrics, Division of Neonatology, Vienna General Hospital, University of Vienna, Vienna, Austria, 2 Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany, 3 Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany, 4 Neonatology, University Hospital of Tuebingen, Tuebingen, Germany

* To whom correspondence should be addressed. E-mail: christian-f.poets{at}med.uni-tuebingen.de.

Sleep-disordered breathing is associated with impaired attention and neurocognitive deficits. We assessed the association of snoring and intermittent hypoxia with poor academic performance in 3rd grade school children (1144 children). Snoring frequency and intermittent hypoxia were investigated using parental questionnaire and nocturnal home pulse oximetry. Intermittent hypoxia was specified as desaturation events to <= 90% SpO2. Poor academic performance was defined as grade 4-6 on a 6-point scale (i.e., approximately the lowest quintile grades) in mathematics, science, reading, spelling, and/or handwriting in the most recent school report. Snoring always was significantly associated with poor academic performance in mathematics (odds ratio; 95% confidence interval: 3.6; 1.3-10.1), science (4.3; 1.3-14.6) and spelling (3.5; 1.2-10.3). Snoring frequently was also significantly associated with poor academic performance in mathematics (2.4; 1.3-4.7) and spelling (2.0; 1.04-3.8). A significant relationship between snoring and poor academic performance was also found in children without intermittent hypoxia, while intermittent hypoxia did not show an independent association with poor academic performance. Thus, habitual snoring (i.e., snoring frequently or always) was associated with poor academic performance in these primary school children.
Key words: Sleep, disordered breathing, oximetry, snoring, hypoxia, learning disorders




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