A community-based cohort of 829 school-aged, 8-11 year-old, children was studied at Case Western Reserve University School of Medicine, Cleveland, OH, to assess the behavioral outcomes of sleep-disordered breathing (SDB), ranging from primary snoring to obstructive sleep apnea (OSA). Forty (5%) children had OSA, 122 (15%) had primary snoring without OSA, and 667 (80%) had no sleep problems. Behavior problem scores were significantly elevated in children with SDB. Behavioral impairments involved externalizing, hyperactive, emotional lability, oppositional, aggressive, internalizing, somatic complaints, and social behavior. Externalizing, hyperactive-type behaviors were especially prominent, having a negative impact on daytime functioning, learning, and school performance. 
COMMENT. Children with externalizing, hyperactive-type and other behavior problems should be investigated for sleep-disordered breathing, including snoring and obstructive sleep apnea. The correction of disturbed sleep patterns should be addressed before or in parallel with the introducion of behavior modifying medications.