PSYCHOLOGY AND COGNITIVE SCIENCES
Open Jou nal h p://dx.doi.o g/10.17140/PCSOJ-1-107
Psychol Cogn Sci Open J
ISSN 2380-727X
Beha io al P oblems and Neu ocogni i e
Func ioning in Sno ing School-Aged
Child en
Ka i Hags öm1*, Ou i Saa enpää-Heikkilä2, Sa i-Leena Himanen3, Anna-Ma ia
Lapinlampi3 and Pi kko Nieminen1
1Psychology Clinic, School o Social Sciences and Humani ies, Uni e si y o Tampe e, Tam-
pe e, Finland
2Depa men o Pedia ics, Tampe e Uni e si y Hospi al, Tampe e, Finland
3Depa men o Clinical Neu ophysiology, Medical Imaging Cen e, Pi kanmaa Hospi al Dis-
ic , Tampe e, Finland; School o Medicine, Uni e si y o Tampe e, Tampe e, Finland
*Co esponding au ho
Ka i Hags öm, MS
Psychology Clinic
School o Social Sciences and
Humani ies
Uni e si y o Tampe e
Kale an ie 4, 33014 Tampe e, Finland
Tel. +358 3 355 111
Fax: +358 3 3551 7345
E-mail: [email p o ec ed]
A icle His o y
Recei ed: No embe 14 h, 2015
Accep ed: Decembe 1s , 2015
Published: Decembe 2nd, 2015
Ci a ion
Hags öm K, Saa enpää-Heikkilä O,
Himanen S-L, Lapinlampi A-M, Ni-
eminen P. Beha io al p oblems and
neu ocogni i e unc ioning in sno ing
school-aged child en. Psychol Cogn
Sci Open J. 2015; 1(2): 46-53. doi:
10.17140/PCSOJ-1-107
Copy igh
©2015 Hags öm K. This is an
open access a icle dis ibu ed un-
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BY 4.0), which pe mi s un es ic ed
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in any medium, p o ided he o igi-
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Resea ch
Page 46
ABSTRACT
Pu pose: To assess he beha io al p oblems and neu ocogni i e unc ioning in sno ing school-
aged child en (6-10 yea s old).
Me hods: Twen y-se en sno ing child en and 35 non-sno ing pee s a ended he s udy. The pa -
en s comple ed he Sleep Dis u bance Scale o Child en (SDSC), an ins umen assessing he
equency o sleep p oblems and sno ing. Beha io al p oblems we e assessed by pa en s wi h
he Child Beha io Checklis (CBCL) and he Conne s’ Pa en Ra ing Scale-Re ised (CPRS-
R) and by eache s wi h he Teache Repo Fo m (TRF) and he Conne s’ Teache Ra ing
Scale-Re ised (CTRS-R). The neu ocogni i e unc ioning o he wo g oups was compa ed
wi h he Wechsle In elligence Scale o Child en (WISC-III) and he De elopmen al Neu o-
psychological Assessmen (NEPSY).
Resul s: On he CBCL, he sno ing child en had mo e in e nalizing p oblems (p<.05) and o al
p oblems (p<.01) han he non-sno ing child en, especially symp oms o anxious/dep essed
mood (p<.01), wi hd awn/dep essed mood (p<.01), and hough p oblems (p<.01). On he
CPRS-R, he sno ing child en had mo e social p oblems (p<.01), hey we e mo e anxious and
shy (p<.01), and hey had mo e psychosoma ic symp oms (p<.05) han he non-sno ing pee s.
Con a y o pa en s, eache s did no epo any beha io al p oblems in sno ing child en. No
di e ences we e ound be ween he wo g oups in he neu ocogni i e assessmen s.
Conclusions: Sno ing school-aged child en a e a isk o in e nalizing p oblems, hough
p oblems, and social p oblems. Child en wi h habi ual sno ing and day ime p oblems should
be e e ed o diagnos ic assessmen and possible ea men .
KEYWORDS: Sno ing; Sleep-diso de ed b ea hing; School-aged child en; Beha io al p ob-
lems; Neu ocogni i e unc ioning.
ABBREVIATIONS: SDSC: Sleep Dis u bance Scale o Child en; CPRS-R: Conne s’ Pa en
Ra ing Scale-Re ised; CBCL: Child Beha io Checklis ; CTRS-R: Conne s’ Teache Ra ing
Scale-Re ised; WISC-III: Wechsle In elligence Scale o Child en; NEPSY: De elopmen al
Neu opsychological Assessmen ; SDB: Sleep-Diso de ed B ea hing; PS: P ima y Sno ing;
OSA: Obs uc i e Sleep Apnea; IQ: In elligence Quo ien ; PSG: Polysomnog aphic; TRF:
Teache Repo Fo m; SPSS: S a is ical Package o he Social Sciences.
INTRODUCTION
The impac o Sleep-Diso de ed B ea hing (SDB) on beha io al ou comes and neu-
ocogni i e unc ions has ecei ed g owing a en ion in he las decade.1 SDB is o en iewed
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as a spec um, wi h P ima y Sno ing (PS, i.e. sno ing wi hou
apnea, hypo en ila ion o sleep agmen a ion) being a he mild
end, and Obs uc i e Sleep Apnea (OSA, i.e. a ious deg ees o
hypoxemia, hype capnia, and sleep agmen a ion) a he mos
se e e end.2,3 Sno ing is a p ima y and majo clinical symp om
in bo h ca ego ies. Sno ing occu s in child en o all ages, bu
sno ing equency is highe among p eschool-aged child en han
among olde child en.4 The p e alence o sno ing in child en
anges om 5-12%, while app oxima ely 1-4% ha e OSA.5
The e is e idence ha childhood sno ing is associa ed
wi h pa en - epo ed beha io al p oblems o bo h ex e nalizing
and in e nalizing na u e.6 The s onges associa ions o ex e -
nalizing beha io s include hype ac i i y, impulsi i y, emo ional
labili y, delinquency, conduc p oblems, agg essi e beha io ,
and opposi ional beha io .7-14 Sno ing child en ha e also in-
e nalizing p oblems, showing mo e anxious/dep essed mood,
soma ic complain s, wi hd awal, hough p oblems, and social
p oblems.10-13,15-18 A ew s udies ha e used eache epo s,6,7,19
showing ha eache s epo subs an ially ewe p oblems han
pa en s. In a s udy by Ali, e al.20 eache s es ima ed ha he chil-
d en in high isk g oup o sleep and b ea hing diso de s we e
mo e hype ac i e and ina en i e han he con ols. On he o he
hand, A man, e al.7 ound no signi ican di e ences in beha -
io al scales a school se ing be ween he wo g oups. Kohle , e
al.6 ound poo ag eemen be ween pa en and eache epo s o
indi idual child beha io .
P e ious s udies ha e epo ed on he signi ican asso-
cia ions be ween childhood sno ing and a di use pa e n o im-
pai men s in neu ocogni i e unc ions. Mos s udies epo sig-
ni ican di e ences be ween sno ing and non-sno ing child en
in in elligence, a en ion, and execu i e unc ions.15,17,19,21-23 Less
commonly epo ed de ici s a e in memo y, isual-spa ial abili y,
language skills, and sensomo o unc ions.9,17 Despi e hese di -
e ences, i is no able ha he mean In elligence Quo ien (IQ)
and sub es sco es o sno ing child en ha e usually been wi hin
he s anda dized no mal ange.22 Poo academic pe o mance
has been ound in sno ing child en,8 as well as highe isk o
academic unde achie emen e en a e sno ing has esol ed.24
In a longi udinal s udy, child en wi h a his o y o SDB in he
i s 5 yea s o li e had inc eased likelihood o ha ing special
educa ional needs a he age o 8.25 To ou knowledge, s udies
widely in es iga ing he associa ion be ween sno ing and bo h
beha io al and neu ocogni i e implica ions a e spa se.9,10,15,17,20
The ocus o he p esen s udy was in school-aged
child en and he aim was o assess he beha io al p oblems
and neu ocogni i e unc ioning in sno ing and nonsno ing
child en. Based on p e ious s udies i was hypo hesized ha
school-aged sno ing child en ha e ele a ed sco es on p oblem
beha io .7,8,11,13,16 In addi ion, i was hypo hesized ha sno ing
school-aged child en pe o m wo se han non-sno ing pee s in
neu ocogni i e unc ioning, showing a di use pa e n wi h a i-
ous mild impai men s in a en ion, execu i e unc ion, e bal
and global in elligence, and memo y.21,26
METHODS
Pa icipan s
This s udy is a pa o a la ge s udy e alua ing sleep
and sleep- ela ed diso de s in school-aged child en. The la ge
s udy consis ed o a sample o 1538 6- o 10-yea -old child en
in Tampe e, Finland. Se en een p ima y schools o a o al 32
loca ed in he ci y o Tampe e we e andomly selec ed. Th ee
p ima y schools o dea , mo o skill diso de ed, speci ic lan-
guage skill diso de ed, and men ally handicapped child en we e
excluded. Pa en s o child en en olling in he i s - o hi d-g ade
classes in selec ed schools ecei ed a ques ionnai e asking he
demog aphics and backg ound da a and he Finnish e sion o
he Sleep Dis u bance Scale o Child en (SDSC), de eloped
and alida ed by B uni, e al.27 SDSC is an ins umen o assess-
ing he equency o sleep p oblems and sno ing in school-aged
child en. The ques ionnai e was handed in physical examina ion
by he school nu se o a class by he eache . The sleep ques ion-
nai e included a ques ion abou sno ing: “How o en does you
child sno e?” The child was classi ied as sno e , i he pa en
answe ed he child o sno e “o en” (3 o 5 nigh s a week) o “al-
ways” (e e y nigh ). Non-sno ing child en sno ed acco ding o
hei pa en s “ne e ” o “occasionally” (1 o 2 nigh s a mon h).
A o al o 831 ques ionnai es we e gi en o he i s -
g ade s and 190 we e e u ned (23%). The hi d-g ade s e-
cei ed 707 ques ionnai es and 101 we e e u ned (14%). Fi e
child en we e excluded om he esea ch da a; ou because o
missing in o ma ion abou sno ing p e alence a e, and one who
was no longe in he i s g ade. Thus, he analyses included 186
i s -g ade s and 100 hi d-g ade s (=286 child en). Finally, 62
pa en s had exp essed willingness o pa icipa e in he clinical
pa o he s udy and hei child en had o e nigh Polysomno-
g aphic (PSG) assessmen and neu ocogni i e es s a he Sleep
Labo a o y in Tampe e Uni e si y Hospi al. All he pa en s ga e
hei in o med w i en consen . The s udy was app o ed by he
E hical Commi ee o Tampe e Uni e si y Hospi al and he Ci y
o Tampe e.
Measu emen s o Beha io al P oblems and Neu ocogni i e
Func ioning
P oblem beha io s we e iden i ied using well- alida ed
and in e na ionally widely used assessmen ools. Beha io al
p oblems we e assessed using he P oblem Scales o he Child
Beha io Checklis (CBCL, pa en e sion)28 and equi alen
Teache Repo Fo m (TRF, eache e sion), bo h o 6- o
18-yea -old child en.28 The ques ionnai es ha e 113 ques ions
and yield 8 scales: Anxious/Dep essed, Wi hd awn/Dep essed,
Soma ic Complain s ( hese h ee cons i u e index o In e nal-
izing P oblems), Social P oblems, Though P oblems, A en-
ion P oblems, Rule-B eaking Beha io , Agg essi e Beha io
(las wo cons i u e index o Ex e nalizing P oblems), and To-
al P oblems. Fo desc ip ion o he da a, he aw sco es o he
CBCL and TRF a e indi idually con e ed in o T-sco es. Scales
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ha e a mean T-sco e o 50 and a s anda d de ia ion o 10. The
bo de line is T=65-69, and he clinical ange is T>69. The bo -
de line ange o In e nalizing, Ex e nalizing and To al P oblems
is T=60-63 and clinical ange T>63. In his s udy he eliabili y
(C onbach alpha) o he CBCL was .945 and o he TRF .952.
The Conne s’ Pa en Ra ing Scale-Re ised (CPRS-R)29
and he Conne s’ Teache Ra ing Scale-Re ised (CTRS-R),29
bo h o 3- o 17-yea -old child en, we e used o iden i y be-
ha io al p oblems as well. The CPRS-R has 80 ques ions and
yields 7 scales: Opposi ional, Cogni i e P oblems/Ina en ion,
Hype ac i i y, Anxious-Shy, Pe ec ionism, Social P oblems,
and Psychosoma ic and he indices A en ion De ici Hype ac-
i i y Diso de (ADHD), Res less-Impulsi e, Emo ional Labil-
i y, To al Index, DSM-IV Ina en i e, DSM-IV Hype ac i e-
Impulsi e, and DSM-IV To al. The CTRS-R has 59 ques ions
and yields same scales excluding Psychosoma ic and has all he
same indices. Fo desc ip ion o he da a, he aw sco es o he
CPRS-R and CTRS-R a e indi idually con e ed in o T-sco es.
The CPRS-R and CTRS-R scales and indices ha e a mean T-
sco e o 50 and a s anda d de ia ion o 10. The bo de line T=56-
60, and T-sco es o 65 and abo e indica e a clinically signi ican
p oblem. In his s udy he eliabili y (C onbach alpha) o he
CPRS-R was .964 and o he CTRS-R .959.
Pa en s comple ed hei ques ionnai es a he Sleep
Labo a o y and eache s a school. On a e age, eache s epo ed
o ha e augh he child o nine mon hs, bu he ange was qui e
b oad; om wo mon hs o 36 mon hs. One child was excluded
om he TRF analyses because he eache had known he only
o one mon h. Achenbach & Resco la28 sugges ha he TRF
can be used when a eache has known a child o a leas wo
mon hs.
Neu ocogni i e unc ions we e assessed wi h s anda d-
ized es s. The es s we e chosen o measu e bo h in ellec ual
unc ioning and speci ic neu ocogni i e unc ions in i e do-
mains. Child en’s in ellec ual unc ioning was e alua ed us-
ing he Finnish e sion o he Wechsle In elligence Scale o
Child en (WISC-III).30 Sco es o Ve bal In elligence Quo ien ,
Pe o mance In elligence Quo ien , and Full Scale In elligence
Quo ien we e es ima ed by he ollowing six sub es s: In o ma-
ion, Simila i ies, A i hme ic, Pic u e Comple ion, Block De-
sign, and Objec Assembly. The in elligence quo ien s ha e a
mean o 100(SD=15).
To e alua e speci ic neu ocogni i e unc ions he De-
elopmen al Neu opsychological Assessmen (NEPSY, Finnish
e sion) was used.31 The NEPSY sub es s we e chosen o ob ain
a comp ehensi e assessmen o each domain o his age g oup.
The i e age-app op ia e domains and hei sub es s we e: A -
en ion and Execu i e Func ion (Towe , Audi o y A en ion and
Response Se , Visual A en ion), Language Func ion (Phono-
logical P ocessing, Comp ehension o Ins uc ions, Speeded
Naming), Sensomo o Func ion (Finge ip Tapping, Imi a ing
Hand Posi ions, Visuomo o P ecision), Visuospa ial Func ion
(Design Copying, A ows), and Memo y and Lea ning Func ion
(Memo y o Faces, Memo y o Names, Na a i e Memo y).
The domains ha e a mean o 10(SD=3). Fo desc ip ion o he
da a, he aw sco es o he WISC-III and he NEPSY we e indi-
idually con e ed in o s anda d sco es.
All child en unde wen a h ee hou neu ocogni i e
e alua ion (wi h one b eak) a he Sleep Labo a o y in Tampe e
Uni e si y Hospi al. A ained psychologis o a ained psychol-
ogy s uden adminis e ed he s anda dized es s indi idually o
each child. The examine was unawa e whe he he child was a
sno e o a non-sno ing one.
S a is ical Analysis
Analysis we e done using he S a is ical Package o
he Social Sciences (SPSS) so wa e (Ve sion 18.0 o Mac OS
X). Due o limi ed numbe o pa icipan s and skewed dis ibu-
ions, he nonpa ame ic Mann-Whi ney U- es was used o es
o g oup di e ences in beha io al and neu ocogni i e pa am-
e e s. Chi squa e analyses we e used o es o g oup di e ences
in socio-economic a iables. P- alues <0.05 we e conside ed
s a is ically signi ican .
RESULTS
Demog aphics and Backg ound Da a
The demog aphics and backg ound da a o he pa ici-
pan s a e p esen ed in Table 1. The da a consis ed o 27 sno ing
child en (11 gi ls and 16 boys) and hei 35 non-sno ing pee s
(17 gi ls and 18 boys). The e we e no signi ican di e ences
o age, gende , as hma, onsillec omy o adenoidec omy. The
g oups did no di e wi h espec o suppo ecei ed a school.
No signi ican di e ences we e ound in pa en al educa ional
s a us o pa en al smoking. The sno ing child en had signi ican -
ly highe Body Mass Index (BMI) han he non-sno ing pee s
(U=312.00, p=.023).
On a e age, acco ding o pa en s, bo h sno ing and
non-sno ing child en slep 9.7 hou s pe nigh . Pa en s epo ed
ha i e (19%) o he sno ing child en sno ed e e y nigh and
22(81%) sno ed 3 o 5 nigh s a week. In he non-sno ing g oup
18(51%) child en ne e sno ed and 17(49%) sno ed occasion-
ally (1 o 2 nigh s a mon h).
Beha io al P oblems
As a g oup, sno ing child en had signi ican ly mo e
p oblems han non-sno ing child en on se e al CBCL and
CPRS-R subscales. Figu e 1 p esen s he main esul s o he
CBCL and he TRF. When measu ed wi h he CBCL, in e -
nalizing p oblems and o al p oblems we e signi ican ly mo e
p e alen in he sno ing g oup. On he In e nalizing scale, 12
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Figu e 1: Sco es on he Child Beha io Checklis and Teache Repo Fo m o sno ing and non-sno ing child en.
p=pa en , = eache
*p<.05. **p< .01.
Sno ing Child en(N=27) Non-sno ing Child en(N=35) P- alue
Mean age(SD) 7.8(1.1) 8.1(1.1) ns
Mean body mass index(SD) 18.6(3.4) 16.7(2.4) .023*
n(%) n(%)
Gende ns
Gi ls 11(40.7) 17(48.6)
Boys 16(59.3) 18(51.4)
Pa - ime special educa ion o
emedial eaching 7(25.9) 7(20.0) ns
As hma 3(11.1) 3(8.6) ns
Tonsillec omy 3(11.1) 2(5.7) ns
Adenoidec omy 9(33.3) 9(25.7) ns
Ma e nal educa ion ns
Basic 0(0) 2(5.7)
Voca ional aining 12(44.4) 15(42.9)
High school 3(11.1) 4(11.4)
Poly echnic 3(11.1) 2(5.7)
Uni e si y 6(22.2) 11(31.4)
Unknown 3(11.1) 1(2.9)
Pa e nal educa ion ns
Basic 3(11.1) 3(8.6)
Voca ional aining 9(33.3) 10(28.6)
High school 2(7.4) 3(8.6)
Poly echnic 2(7.4) 4(11.4)
Uni e si y 8(29.6) 14(40.0)
Unknown 3(11.1) 1(2.9)
Pa en al smoking ns
Mo he 6(22.2) 7(20.0)
Fa he 4(14.8) 7(20.0)
Unknown 6(22.2) 6(17.1)
Table 1: Demog aphics and backg ound da a o sno ing and non-sno ing child en.
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child en (44%) o he sno ing g oup and only one child in he
non-sno ing g oup sco ed on he clinical ange. Sno ing child en
also had s a is ically highe sco es han non-sno ing child en on
he ollowing CBCL subscales: Anxious/Dep essed, Wi hd awn/
Dep essed and Though P oblems. No signi ican di e ence was
ound be ween he g oups in he amoun o ex e nalizing p ob-
lems.
The eache s did no epo many signi ican beha io al
p oblems in he TRF in sno ing child en. Besides his, he each-
e s a ed sno ing child en wi h lowe sco es in all scales and
indices han he pa en s did. This endency was no as e iden
wi h non-sno ing child en. Teache s es ima ed in he TRF ha
non-sno ing child en had signi ican ly mo e soma ic symp oms
han sno ing child en (U=254.00, p=.025).
Figu e 2 shows he esul s o he CPRS-R and he
CTRS-R. Based on he CPRS-R sco es, sno ing child en we e
signi ican ly mo e anxious and shy and had mo e social p ob-
lems and psychosoma ic symp oms han non-sno ing pee s (Fig-
u e 2). Twel e sno ing (44%) and 6 non-sno ing (18%) child en
sco ed on he bo de line o clinical ange on he Psychosoma ic
scale, 11 sno ing (41%) and 3 non-sno ing (9%) child en on he
Social P oblems scale and 9 sno ing (33%) and 4 non-sno ing
(12%) child en on he Anxious-Shy scale. The eache s did no
epo many signi ican beha io al p oblems in he CTRS-R in
sno ing child en. In he CTRS-R, he eache s es ima ed non-
sno ing child en o be signi ican ly mo e impulsi e and hype ac-
i e han sno ing child en (U=231.00, p=.042). Al hough he e
was a lo o a iabili y in how long he eache had augh he
child ( om wo mon hs o 36 mon hs), no s a is ically signi ican
di e ences we e ound be ween sno ing and non-sno ing g oups
in hese imes.
Neu ocogni i e Func ions
Table 2 summa izes he esul s o he neu ocogni i e
unc ions. On a e age, in ellec ual unc ioning was wi hin no -
mal ange o bo h g oups. Al hough sno ing child en had lowe
sco es han non-sno ing pee s on each WISC-III sub es s and in
Ve bal, Pe o mance and Full Scale IQ sco es, hese di e ences
we e no s a is ically signi ican . Simila ly, he pe o mance o
bo h g oups in he NEPSY sub es s was wi hin no mal ange.
The e we e no signi ican di e ences be ween he g oups in any
o he ou een sub es s o in he i e neu ocogni i e domains.
DISCUSSION
The aim o his s udy was o desc ibe beha io al p ob-
lems and neu ocogni i e unc ioning in sno ing and non-sno ing
school-aged child en. P e iously, only a ew s udies ha e widely
in es iga ed bo h beha io al p oblems and neu ocogni i e unc-
ions in sno ing school-aged child en.
Fi s ly, as expec ed, he indings in his s udy indica e
ha sno ing child en ha e mo e pa en - epo ed in e nalizing
beha io al p oblems (including anxious, dep essed, wi hd awn,
and psychosoma ic symp oms), hough p oblems, social p ob-
lems, and o al p oblems han hei non-sno ing pee s. Mo eo e ,
sno ing child en no only had highe incidence o in e nalizing
p oblems, he p oblems also we e mo e se e e, showing ha al-
mos hal o he child en had clinically signi ican symp oms.
These indings a e consis en wi h exis ing SDB s udies show-
ing ha child en wi h sno ing ha e mo e beha io al p oblems
Figu e 2: Sco es on he Conne s’ Pa en Ra ing Scale-Re ised (CPRS-R) and Conne s’ Teache Ra ing Scale-Re ised (CTRS-R)
o sno ing and non-sno ing child en.
p=pa en , = eache
#=no e alua ed by eache s
*p<.05. **p<.01.

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han hei non-sno ing pee s, pa icula ly symp oms o wi h-
d awn, dep essed and anxious mood, soma ic complain s, social
p oblems, and hough p oblems.16,17 Simila indings ha e been
epo ed in younge child en; A onen, e al.15 ound in a Finn-
ish p eschool g oup (aged 3-6 yea s) ha sno ing child en had
signi ican ly mo e in e nalizing symp oms, especially anxious
and dep essed mood and emo ional eac i i y han non-sno ing
pee s. Despi e hese pa en - epo ed beha io p oblems, each-
e s in his s udy did no epo sno ing child en o ha e mo e
beha io al p oblems han non-sno ing pee s. Teache s a ed
child en wi h lowe sco es han pa en s.6,7,19
Hypo hesis conce ning ele a ed ex e nalizing beha io -
al p oblems was no con i med; in con as o p e ious s udies,11
cu en esul s do no suppo he associa ion be ween sno ing
and ex e nalizing beha io al p oblems, especially hype ac i i y,
opposi ional and agg essi e beha io in sno ing child en. In his
s udy, ex e nalizing symp oms we e no mo e equen in sno e s
han non-sno e s.
Secondly, on he basis o p e ious s udies,20,21,26 i was
hypo hesized ha di use neu ocogni i e impai men s would be
p esen in child en wi h sno ing. Al hough, analyses showed ha
sno e s had lowe sco es in he in ellec ual unc ions, hese di -
e ences we e no s a is ically signi ican . In addi ion, sno e s’
in elligence quo ien s we e wi hin he no mal ange. This means
ha con a y o ini ial hypo hesis, in neu ocogni i e measu e-
men s he e we e no signi ican di e ences be ween he wo
g oups. All s udied child en a ended mains eam schools and
ecei ed only pa - ime special educa ion o emedial eaching,
which may pa ially explain hese esul s. The e we e no chil-
d en wi h obse ed lea ning disabili ies among pa icipan s.
In his s udy i was conside ed impo an o ob ain
eache s’ obse a ions on child en’s beha io in he school se -
ings, because objec i e measu es in na u alis ic se ings o he
han pa en s ha e been spa se and esul s ha e been con o e -
sial. The inconsis ency be ween pa en and eache epo s o be-
ha io was e iden in his s udy, especially in he sno ing g oup.
This is consis en wi h p e ious epo s showing ha pa en s and
eache s pe cei e he same child en qui e di e en ly.7,29,32 The
di e ence in pa en and eache epo s in his s udy b ings some
possible explana ions in o mind. Fi s , he e was some a ia ion
in how long he eache had known he child. Teache s wi h he
lowes knowing ime migh ha e been cau ious in epo ing in-
e nalizing beha io al p oblems. Second, in he class oom chil-
d en wi h in e nalizing p oblems a e less isible han child en
wi h impulsi e-hype ac i e p oblems o agg essi eness. The e-
o e, eache s may ha e had di icul ies in ecognizing anxious,
dep essed, and shy child en in he class. Thi dly, poo ag eemen
be ween pa en s and eache s may also e lec he ac ha chil-
d en beha e di e en ly a home and in school en i onmen . A
home hey a e mo e likely o show emo ional di icul ies o hei
pa en s and a school demands o beha io a e di e en .
The e a e se e al s eng hs in he p esen s udy. This
s udy has he ad an age o using simul aneously pa en - and
eache - epo ed da a, age-app op ia e con ol g oup and s an-
da dized es s o neu ocogni i e unc ions and widely used and
well- alida ed a ing scales. Pa icipan s in his s udy we e e-
c ui ed om he local mains eam schools and we e no being
e alua ed o sleep dis u bances, beha io al p oblems o neu o-
cogni i e p oblems. The ques ionnai es we e handed o all chil-
d en, so he o iginal sample o 1538 child en was ep esen a i e,
and i can be hough ha he pa icipan s in his s udy ep esen
Finnish pupils a ending mains eam schools. The da a consis ed
only school child en aged 6-10, so he age ange is e y limi ed
compa ed o many o he SDB s udies.
The cu en s udy has also limi a ions. The da a on bo h
Sno ing child en (N=27)
Mean±SD (Range)
Non-sno ing child en (N=35)
Mean±SD (Range)
P- alue
Mann-Whi ney
U- es
WISC-III
In elligence
Ve bal 101.6±16.0(73-131) 107.3±16.9(73-156) .221
Pe o mance 99.4±17.4(64-136) 106.3±18.6(71-132) .123
Full scale 100.2±14.8(75-124) 105.9±16.4(76-141) .164
NEPSY
Domains
A en ion and Execu i e Func ion 11.4±2.0(8-16) 11.4±2.0(7-15) .870
Language Func ion 10.5±2.0(6-15) 10.5±2.5(6-14) .943
Sensomo o Func ion 10.4±1.9(5-14) 10.4±1.6(7-13) .609
Visuospa ial Func ion 10.2±2.4(5-14) 10.8±2.3(5-15) .354
Memo y and Lea ning 9.9±2.6(3-14) 9.9±2.1(6-13) .837
Table 2: Mean S anda d sco es, s anda d de ia ions, and anges o he WISC-III in elligence sco es and NEPSY domains o sno ing and non-
sno ing child en.
PSYCHOLOGY AND COGNITIVE SCIENCES
Open Jou nal h p://dx.doi.o g/10.17140/PCSOJ-1-107
Psychol Cogn Sci Open J
ISSN 2380-727X
Page 52
sno ing and beha io al p oblems elied on pa en al epo s. Reli-
ance on pa en al pe cep ions may in oduce po en ial measu e-
men e o . I has been sugges ed33 ha pa en al- epo ques ion-
nai es o child en’s sno ing can be used as subs i u e p edic o s
o sno ing. In s udies by O’B ien, e al.17 and Blunden, e al.19
pa en - epo ed sno ing was con i med by polysomnog aphy.
Taken oge he , pa en s seem o be anapplicable sou ce o in o -
ma ion ega ding hei child en’s sno ing. Because he ca ego i-
za ion o he child en in o sno ing and nonsno ing g oups in his
s udy was based on pa en al epo ed sno ing, i was no possible
o examine associa ion be ween sno ing se e i y and beha io al
o neu ocogni i e impai men s.
The pa icipa ion pe cen was qui e low, p obably due
o incon enience o he s udy p o ocol. Du ing he PSG s ud-
ies, he child en (and mos pa en s) slep wo successi e nigh s
a he sleep labo a o y and a he day o he psychological as-
sessmen child en we e absen om school. Fo some amilies
his may ha e been oo demanding o a p ocedu e and he e o e
hey chose no o pa icipa e in he clinical pa o he s udy.
Ra he han ha ing age and gende ma ched con ols, we chose
o use non-sno ing pa icipan s as con ols. Ma ching he wo
g oups p ecisely o age and gende would ha e been oo ime-
consuming and di icul , especially gi en he small numbe o
pa icipan s.
The cause o obse ed beha io p oblems canno be
answe ed by his s udy. The beginning o du a ion o sno ing
was no examined. S udies in es iga ed pedia ic sno ing longi-
udinally a e needed o cla i y his issue. Po en ial mechanisms
o hese p oblems in sno ing a e unknown and need u he in-
es iga ion.
In conclusion, he esul s o his s udy indica e ha
compa ed wi h non-sno ing pee s, school-aged sno ing chil-
d en a e a isk o in e nalizing p oblems, hough p oblems,
and social p oblems. Child en who ha e sleep- ela ed symp oms
should be e e ed o diagnos ic es ing and possibly ea men .
Also child en wi h day ime somnolence, p oblems wi h beha -
io , o school pe o mance, should ha e hei sleep e alua ed.
Al hough he e we e no neu ocogni i e p oblems o be shown
be ween he wo g oups in his s udy, in e nalizing p oblems,
i no ea ed, may cause se e e consequences in he long un,
leading o social isola ion, se e e psychological di icul ies,
lea ning p oblems, and poo school pe o mance.
ACKNOWLEDGMENT
This s udy was inancially suppo ed by Compe i i e S a e Re-
sea ch Financing o he Expe Responsibili y a ea o Tampe e
Uni e si y Hospi al (G an s 9P013, 9R007, 9S007).
CONFLICTS OF INTEREST
The au ho s ce i y ha he e is no con lic o in e es ega ding
he ma e ial discussed in he manusc ip .
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