Behavioral Patterns in Preschool and School-Aged Children with Snoring and Sleep-Disordered Breathing: A Scoping Review.

Objective

This scoping review aims to map the scientific literature of the last five years to characterize behavioral patterns in children with snoring and sleep-disordered breathing (SDB), ranging from primary snoring (PS) to obstructive sleep apnea syndrome (OSAS). The review seeks to identify the main diagnostic and assessment methods, differentiate the behavioral findings between PS and OSAS where possible, and pinpoint key research gaps.

Methods

A systematic scoping review was conducted following the PRISMA-ScR guidelines. The PubMed/MEDLINE, LILACS, and SciELO databases were searched in April 2024 for observational studies published between 2019 and 2024 that addressed the coexistence of snoring and behavioral changes in the pediatric population. Only articles in English, Spanish, or Portuguese were analyzed. Data were charted and analyzed thematically to map the scope of the evidence.

Results

The initial search yielded 129 articles, with 22 ultimately included in the final analysis. The findings reveal profound methodological heterogeneity. While questionnaires are universally applied (n = 22), polysomnography (n = 21) remains the gold standard for SDB diagnosis. Behavioral assessments were inconsistent, identifying a broad spectrum of externalizing (e.g., hyperactivity, aggression) and internalizing (e.g., anxiety, depression) problems, with no clear predominant pattern. Obesity and Down's syndrome were the most frequently associated comorbidities.

Conclusions

The literature reaffirms the strong correlation between SDB and adverse neurobehavioral outcomes in children. This association is present in primary snoring but is most pronounced in children with diagnosed OSAS. However, progress is constrained by a lack of standardization and, critically, a frequent failure to differentiate between PS and OSAS, which hinders clinical interpretation and evidence synthesis.