Abstract
ObjectiveTo investigate the relationship between breastfeeding and snoring in childhood.MethodsIn a cohort of children with a family history of asthma who were recruited antenatally we prospectively recorded data on infant feeding practices throughout the first year of life. Snoring status and witnessed sleep apnea were measured at age 8 years by parent-completed questionnaire. Associations were estimated by logistic regression with, and without, adjustment for sets of confounders designed to exclude biasing effects.ResultsHabitual snoring was reported in 18.8% of the sample, and witnessed apnea in 2.7%. Any breastfeeding for longer than one month was associated with a reduced risk of habitual snoring at age 8 (adjusted OR 0.48, 95% CI 0.29 to 0.81) and duration of breastfeeding was inversely associated with the prevalence of habitual snoring (adjusted OR 0.79, 95% CI 0.62 to 1.00). Any breastfeeding for longer than 1 month was associated with a lower risk of witnessed sleep apnea (adjusted OR 0.17, 95% CI 0.04 to 0.71). The protective associations were not mediated by BMI, current asthma, atopy or rhinitis at age 8 years.ConclusionsBreastfeeding for longer than one month decreases the risk of habitual snoring and witnessed apneas in this cohort of children with a family history of asthma. The underlying mechanism remains unclear but the finding would be consistent with a beneficial effect of the breast in the mouth on oropharyngeal development with consequent protection against upper airway dysfunction causing sleep-disordered breathing.
Highlights
Sleep disordered breathing (SDB) refers to a range of respiratory sleeping outcomes from primary snoring to obstructive sleep apnea (OSA)
Both OSA and SDB occur in children of all ages from neonates to late adolescents [12,13] it is thought to be most common in 3–6 year olds when the size of the adenoid and tonsils is greatest compared to the throat diameter. [14]
Of the 616 participants recruited at birth, 64 withdrew from the study by 18 months, a further 58 withdrew by 8 years and a further 45 were not available for clinical assessment at 8 years
Summary
Sleep disordered breathing (SDB) refers to a range of respiratory sleeping outcomes from primary snoring to obstructive sleep apnea (OSA). The biological plausibility for this hypothesis comes via the mechanical effects of feeding from the breast, compared to a bottle, on the still plastic oral structures.[15] Two cohort studies have found that some breastfeeding reduces the risk of habitual snoring in children aged 1.5–6 years.[11,16] other studies including our own have found that, breastfeeding for the recommended six months or more, compared to less than six months, was not associated with risk of habitual snoring in children aged 1 to 14 years.[10,17,18,19] This suggests that breastfeeding in the first few months of life, rather than a long duration of feeding, may be important in preventing the development of habitual snoring in young children (critical timing of exposure).
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