Snoring In Children Research Articles

Suggestions on the diagnostic criteria of childhood obstructive sleep apnea hypopnea syndrome

To evaluate the sleep architecture and hypoxia and clinical features of habitual snoring children with an obstructive sleep apnea-hypopnea index (OAHI) 1 to 5. The polysomnographic data of 267 children aged from 2 to 16 years with habitual snoring were analyzed retrospectively, and the clinical features were analyzed in 108 of the children. The recruited children were divided into primary snoring group (PS group, OAHI≤1), obstructive sleep apnea hypopnea syndrome (OSAHS) group (1<OAHI≤5 and obstructive apnea index≤1), lowest oxygen saturation (LSpO2≤0.92) and OSAHS group (OAHI>5 or dostructive apnea index>1, LSpO2<0.92). The oxygen desaturation index of the intermediate OSAHS group (3.8±0.4) was significantly higher than that of PS group (1.6±0.1) (χ2=34.5, P<0.01). The LSpO2 of intermediate OSAHS group was significantly lower than that of PS group (89(87,91) vs. 93(91,94), χ2=40.2, P<0.01). Comparing to the PS group, the non-rapid eye movement 1 ratio (N1%) was significantly higher (19.0±1.2 vs. 14.2±0.1, χ2=14.1, P<0.01), and the non-rapid eye movement 3 ratio (N3%) was significantly lower (24.4±1.0 vs. 29.0±1.1, P<0.01) in the intermediate OSAHS group. The pediatric questionnaire score intermediate OSAHS group was higher than PS (0.41±0.19 vs. 0.28±0.14, χ2=8.52, P=0.01). The adenoids-nasopharynx ratio was higher than that of PS group (0.70±0.07 vs. 0.62±0.10, χ2=8.96, P=0.01). The hypertrophy of tonsil was higher than PS group (2(1,2) vs. 1(1,2), χ2=7.95, P<0.05). Hypoxia and abnormal sleep structure are present in HS children with an OAHI of 1 to 5, and they also have the clinical features of OSAHS.

Friedman tongue position: Age distribution and relationship to sleep-disordered breathing

PurposeFriedman tongue position (FTP) may play an important role in the evaluation of children with sleep-related breathing disorders (SRBD), but there are no previous data on FTP distribution by age. The objective of the current study was to determine the distribution of FTP by age and examine the relationship between FTP and snoring in children. MethodsProspective cross-sectional study of 199 children (mean age, 6.8 years; 59% male) had tongue position assessed by FTP as part of their clinical examination of the oral cavity during routine ENT visits at a tertiary care children's hospital. The FTP and snoring frequency of participants was examined across the entire age range as well as by comparing those older (middle childhood and above) and younger than 5 years of age. ResultsTongue position did not correlate with age or snoring frequency. The proportion of children with FTP III/IV was not significantly different in children younger than five years of age compared to older than five. Habitual snoring was not associated with having a higher FTP. Among children who snored <3 times per week, those who had previously undergone tonsillectomy did have higher FTP compared to those who had not (p=0.007). BMI-%-for-age was significantly correlated with FTP (p=0.003). The percent of children having FTP class III/IV differed significantly between ethnicities (22% of whites, 26% of others, 45% of hispanics, 53% of African–Americans; p=0.011). Inter-rater reliability among pediatric otolaryngologist was excellent (kappa=0.93, p<0.001). ConclusionsThere does not appear to be an association between FTP with age or snoring frequency in children. The excellent inter-rater reliability for FTP among pediatric ENT providers suggests the null findings are not due to rater bias. These findings may serve as an important reference for those studying the role of tongue position in pediatric SRBD and complement previous studies examining FTP among children with known OSA or snoring.

Natural history of snoring in Hong Kong adolescents.

To determine the natural history of snoring in children when they reached adolescence and the underlying risk factors for persistence of habitual snoring. A follow-up telephone survey was conducted to determine the natural history of snoring in children who reached adolescence. The targeted interviewees of the follow-up survey were parents of 3047 children. Adolescents who were snoring ≥6 nights a week were defined as habitual snorers. Potential risk factors for persistent and incident habitual snoring were studied, including age, gender, allergic rhinitis, asthma, body mass index (BMI), sleep duration and daytime sleepiness. Of the 3047 subjects, 2005 (65.8%) were successfully interviewed by phone. The prevalence of habitual snorers was 12.7%. Ninety-one adolescents were persistent habitual snorers. Allergic rhinitis, male gender and higher BMI at follow-up were identified as significant risk factors for persistent habitual snoring. A further 163 children were identified as incident habitual snorers. The risk factors for incident habitual snoring included male gender, asthma, higher BMI at follow-up and younger age at the first survey. In the current study, the mean sleep duration was 7.6 ± 1.0 h. Overall, 90% of the current cohort slept less than the lower limit of international recommendations for sleep duration. Around 40.6% of habitually snoring children continued to snore habitually as adolescents in the current study, while 9.2% of the initial non-habitual snorers became habitual snorers. Male gender and higher BMI were significant risk factors for both persistent and incident habitual snoring.

Prospective cohort study on change in weight status and occurrence of habitual snoring in children.

To determine the association between the change in weight status and newly developed snoring in children. This was a prospective cohort study. Structured interviews were conducted at participants' homes, and physical examinations were performed at The-pa Community Hospital in Southern Thailand. Cohort subjects (n=1076) were recruited from children born over a 1-year period between November 2000 and October 2001 in The-pa District of Songkhla Province, Southern Thailand. Data collection was performed when the child was 5 and 8.5years old. The child's snoring, weight, height and tonsillar size were examined. The change in weight status was categorised into four groups: not obese, became not obese, became obese and persistently obese. Of 1076, 983 subjects (91.4%) completed both surveys. The overall prevalence of habitual snoring decreased from 13% at age 5 to 10.9% at age 8.5years. Of the 855 children who reported not snoring in the first survey, 61 (7.1%) had become habitual snorers. After adjusting for tonsillar size, children who had become obese or were persistently obese had a significant association with becoming a new snorer with an odds ratio of 5.8 (Confidence interval, CI, 1.3-25.8) and 11.7 (CI, 2.5-54.9), respectively. Children with newly developed obesity at 8.5years old were strongly associated with new snoring occurrence, which is similar to the findings of long-term follow-up studies in adults. Our findings support the idea that the patterns of changes in weight status and snoring development in adults begin as early as the primary school years.

Long-term changes in heart rate variability in elementary school–aged children with sleep-disordered breathing

ObjectiveSleep-disordered breathing (SDB) in adults and children has been associated with reduced heart rate variability (HRV) indicative of autonomic dysfunction, which in turn is associated with an increased risk for cardiovascular morbidity. However, the long-term effects of pediatric SDB that has either resolved or remains unresolved on HRV are unknown. MethodsForty Children with previously diagnosed SDB and 20 non snoring controls underwent repeat overnight polysomnography (PSG) four years after the original diagnosis. At follow-up, children aged 11 to 16years were categorized into resolved (absence of snoring and obstructive apnea hypopnea index [OAHI]⩽1) or unresolved (continued to snore or had an OAHI>1) groups. HRV was assessed using power spectral analysis for each sleep stage. ResultsThere were no group differences in age, sex or body mass index (BMI) z score. Both the resolved and unresolved SDB groups showed significant improvement in OAHI. The control, resolved, and unresolved groups all showed a significant reduction in total power (P<.001), low-frequency (LF) power (P<.05), high-frequency (HF) power (P<.001), and an increase in the LF/HF ratio (P<.001) from baseline to follow-up in all sleep stages. ConclusionsHRV did not differ between non snoring children and children with resolved and unresolved SDB four years after initial diagnosis, concomitant with a significant reduction in OAHI in both SDB groups. All groups demonstrated a decrease in HRV from baseline to follow-up which may reflect an age-related phenomenon in these children.

Habitual Snoring in Children with Previous Allergic Sensitization

Previous studies have reported a high prevalence of allergy in children with Habitual Snoring (HS), but the relationship between allergy in the early years of life and the subsequent development of this Sleep Disordered Breathing (SDB) is yet to be elucidated. The purpose of the present study was to determine the role of early, under 36 months of age, allergic sensitization to food (with or without sensitization to airborne allergens) in determining the development of HS 8-10 years after. One hundred and forty-eight children (10-14 years, mean age 12 years) with a history of food allergy were selected. Under the age of 36 months, atopic status was assessed by skin prick test for a panel of airborne and food allergens. Questionnaires filled in by parents were used to collect information on children's snoring and associated symptoms. HS was defined as snoring three or more times per week. At 1-3 years of age 54 children were positive to food allergens alone, and 94 were positive also to airborne allergens. After 8-10 years of life, when patients were aged between 10 and 14 years, habitual snoring was reported in 37 children. Furthermore, among the 54 children under three years of age sensitized only to food, 8 became HS while of the 94 children sensitized to both food and inhalants allergens 29 developed HS. The difference between those two groups was statistically significant (p=0.04). We reported a significant risk of developing HS in children with early allergic sensitization. Specifically this risk was higher when food allergy was associated with inhalant allergy. The onset of upper airway inflammation due to allergic triggers in subjects under three years of age may be related to the subsequent development of SDB after 8-10 years.

Evaluation of children with habitual snoring and unilateral cleft lip and palate by Ricketts analysis—Relationship between craniofacial morphology and pharyngeal airway space

Our previous studies reported that habitual snoring children with unilateral cleft lip and palate (UCLP) had a large anterior facial height and narrow airway, but the sagittal position of maxilla a...

Craniofacial morphology and pharyngeal airway space in children with habitual snoring and unilateral cleft lip and palate—Part II: Comparison with non-clefted habitual snoring children

It is known that various factors are related to the habitual snoring, such as mouth breathing, obesity, deviation of nasal septum, and respiratory muscle. Patients with cleft lip and palate are acc...

Current practice patterns for sleep‐disordered breathing in children

Since the primary therapy for children with sleep-disordered breathing(SDB) is adenotonsillectomy, a survey was developed to determine the current practice patterns for children with SDB by pediatric otolaryngologists. Cross-sectional survey An Internet-based survey was sent to all American Society of Pediatric Otolaryngology members. In addition to descriptive statistics, a logistic regression was performed to assess if years in practice, polysomnogram (PSG) wait time, or frequency of evaluating snoring children changes management. The response rate was 39% (135/345). Children with SDB were "most of the time" referred for PSGs by 4% of respondents. Sixty-five percent referred for PSG "sometimes," and 31% referred "rarely" or "never." An increased wait time was a significant predictor of PSG frequency (OR = 1.10, 95% CI: 0.92-1.0, P = 0.039). Children with Down syndrome or obesity had preoperative PSG requested "always" 20% and 8% of the time. The primary reason for requesting a PSG in a normal child was inconsistent clinical evaluation (58%). To diagnose obesity, most (72%) record height and weight, but only 34% record BMI% for age. Overnight observation was performed "most of the time" for the following groups: Obese (70%), Down syndrome (83%), and <3 years (83%). Pediatric otolaryngologists are noncompliant with the 2002 American Academy of Pediatrics and the 2011 American Academy of Otolaryngology-Head and Neck Surgery guidelines. Despite noncompliance, they fortunately have a lower threshold to monitor high-risk children overnight following surgery. The recommended Center for Disease Control measures to diagnose childhood obesity occasionally are being utilized. An educational campaign is necessary to update clinicians who take care of children on the new evidence-based guidelines.

A Clinical Study on 83 Cases of Snoring in Children

A Clinical Study on 83 Cases of Snoring in Children

A Clinical Study on 83 Cases of Snoring in Children

A Clinical Study on 83 Cases of Snoring in Children

Pediatric sleep disorders and special educational need at 8 years: a population-based cohort study.

To examine associations between sleep-disordered breathing (SDB) and behavioral sleep problems (BSPs) through 5 years of age and special educational need (SEN) at 8 years. Parents in the Avon Longitudinal Study of Parents and Children reported on children's snoring, witnessed apnea, and mouth-breathing at 6, 18, 30, 42, and 57 months, from which SDB symptom trajectories, or clusters, were derived. BSPs were based on report of ≥ 5 of 7 sleep behaviors at each of the 18-, 30-, 42-, and 57-month questionnaires. Parent report of SEN (yes/no) at 8 years was available for 11049 children with SDB data and 11467 children with BSP data. Multivariable logistic regression models were used to predict SEN outcome by SDB cluster and by cumulative report of SEN. Controlling for 16 putative confounders, previous history of SDB and BSPs was significantly associated with an SEN. BSPs were associated with a 7% increased odds of SEN (95% confidence interval [CI] 1.01-1.15), for each ∼1-year interval at which a BSP was reported. SDB, overall, was associated with a near 40% increased odds of SEN (95% CI 1.18-1.62). Children in the worst symptom cluster were 60% more likely to have an SEN (95% CI 1.23-2.08). In this population-based longitudinal study, history of either SDB or BSPs in the first 5 years of life was associated with increased likelihood of SEN at 8 years of age. Findings highlight the need for pediatric sleep disorder screening by early interventionists, early childhood educators, and health professionals.

Obstructive Sleep Apnea and Primary Snoring in Children With Epilepsy

Sleep-related breathing disruptions in children with epilepsy are common and can range from primary snoring to obstructive sleep apnea. Untreated obstructive sleep apnea can lead to significant morbidity. This study aimed to identify factors associated with its occurrence and severity in children with epilepsy. Children with epilepsy and sleep disruption were evaluated with polysomnography and diagnosed with obstructive sleep apnea or primary snoring. Statistical analyses were done to identify differences within both the groups and among the subjects in the obstructive sleep apnea group. Uncontrolled epilepsy was a risk factor for obstructive sleep apnea (80%) compared with primary snoring (47%, P = .02). Obstructive index increased with increasing number of antiepileptic drugs. In children with epilepsy and disturbed sleep, obstructive sleep apnea is associated with uncontrolled epilepsy and is more severe with polytherapy use. Children with uncontrolled seizures on antiepileptic polytherapy should be routinely screened for obstructive sleep apnea.

Novel methods to diagnose obstructive sleep apnea in children

Sleep-disordered breathing encompasses a spectrum of disorders that increase in severity from snoring to obstructive sleep apnea (OSA). OSA is a clinical disorder that requires a polysomnogram (PSG) to make the diagnosis. The PSG is the gold standard to confirm OSA. Alternative diagnostic tests are presented to supplement the clinical evaluation with objective information when evaluating the snoring child. Diagnostic tests to identify the anatomical site of obstruction are also discussed.

Validation of sleep‐related breathing disorder scale in Hong Kong Chinese snoring children

The purpose of this study is to validate the previously-validated Taiwan Chinese version of Sleep-Related Breathing Disorder scale (SRBD scale) in Hong Kong Chinese snoring children. SRBD scale is an instrument used for prediction of obstructive sleep apnea syndrome. (OSA) The Chinese version of SRBD scale were previously translated and validated in Taiwan. The same questionnaire were administered in a group of 102 snoring children (mean age: 10.7 and 65 boys) from a sleep laboratory in Hong Kong before their sleep studies. The SRBD scores were then validated against the results from sleep studies. By using the definition of apnea-hypopnea index larger than 1.5 as OSA, 28 children (27.5%) had polysomnography-confirmed OSA. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the previously validated cut-off of SRBD score > 0.33 for OSA were 0.5, 0.55, 1.12, and 0.90, respectively. The area under ROC curve was only 0.58, indicates suboptimal performance of SRBD score in predicting OSA. In summary, our study concluded that the previously reported Chinese SRBD scale is not accurate in identifying presence of OSA in Hong Kong Chinese snoring children.

Association between primary nocturnal enuresis and habitual snoring in children with obstructive sleep apnoea-hypopnoea syndrome

IntroductionNocturnal enuresis (NE) and obstructive sleep apnoea-hypopnoea syndrome (OSAHS) are common problems during childhood, and population studies have reported a significant correlation between them. This study aimed to assess whether habitual snoring, mouth breathing and daytime sleepiness are associated with increased incidence of NE in children with OSAHS.Material and methodsPolysomnography was performed in 42 children (66.7% males), 3.5-14.5 years old, who were evaluated for sleep-disordered breathing (SDB).ResultsFourteen out of 42 children (33.3%) presented mild, 16 out of 42 (38.1%) moderate and 12 out of 42 (28.6%) severe degree of OSAHS. Apnea hypopnea index (AHI) ranged between 1.30-94.20 (10.54 ±15.67) events per hour of sleep. Nocturnal enuresis was reported in 7/42 (16.7%) of them. The main observed symptoms were snoring (90.5%), restless sleep (81%), mouth breathing (71.4%), nasal congestion (76.2%), and difficulty in arousal (52.4%). A statistically significant association was found between NE and mouth breathing (p = 0.014) or nasal congestion (p = 0.005). Children with OSAHS and NE had a higher arousal index (8.14 ±8.05) compared with OSAHS children without NE (4.61 ±7.95) (p = 0.19, z = –1.28). Snorers had higher levels of AHI (11.02 ±16.37) compared with non-snorers (6.05 ±4.81) (p = 0.33, z = –0.96), and habitually snorers (23/42, 54.76%) were at greater risk of having NE (4/23) than were non-snorers (0/4, p = 0.36). However, the prevalence of enuresis was not related to the severity of OSAHS, expressed as AHI (p = 0.70).ConclusionsMouth breathing, nasal congestion and high threshold of arousal during sleep should be more carefully evaluated in cases of children with NE who do not respond to standard treatment and present SDB.

Prevalence of habitual snoring in children and occurrence of peri-operative adverse events

To describe the prevalence of habitual snoring and examine its association with peri-operative adverse events in children undergoing elective non-cardiac surgery--a relationship that has not been previously characterised. Using a prospective observational design, we studied children aged 6-18 years undergoing elective non-cardiac surgeries at our institution. Trained research assistants collected clinical (including peri-operative adverse events) and anthropometric data on all individuals. Patients were stratified into two classes, habitual snorers and non-snorers. Subsequently, univariate factors associated with snoring were explored and then odds ratios for the occurrence of peri-operative adverse events were calculated from logistic regression after controlling for clinically relevant cofactors. Among 1102 patients, the prevalence of habitual snoring was 27.3% (28.2% for boys vs. 26.3% for girls). All the measured anthropometric parameters (BMI, waist circumference and neck circumference) were significantly higher in habitual snorers compared with non-snorers. The overall respiratory complication rate was 11.1%. Respiratory adverse events were more frequent in habitual snorers compared with non-snorers (16.9 vs. 8.9%; P < 0.001). Additionally, habitual snoring was associated with longer post-anaesthesia care unit (PACU) stay (114.0 ± 49.6 vs. 103.6 ± 48.9 min; P = 0.002) even after controlling for the occurrence of adverse respiratory events. The prevalence of habitual snoring was high in this cohort of paediatric surgical patients. Habitual snoring was associated with some peri-operative adverse events and prolonged PACU stay and should be considered an important symptom in the pre-operative review of children.

Habitual Snoring in school-aged children: environmental and biological predictors

BackgroundHabitual snoring, a prominent symptom of sleep-disordered breathing, is an important indicator for a number of health problems in children. Compared to adults, large epidemiological studies on childhood habitual snoring and associated predisposing factors are extremely scarce. The present study aimed to assess the prevalence and associated factors of habitual snoring among Chinese school-aged children.MethodsA random sample of 20,152 children aged 5.08 to 11.99 years old participated in a cross-sectional survey, which was conducted in eight cities of China. Parent-administrated questionnaires were used to collect information on children's snoring frequency and the possible correlates.ResultsThe prevalence of habitual snoring was 12.0% (14.5% for boys vs. 9.5% for girls) in our sampled children. Following factors were associated with an increased risk for habitual snoring: lower family income (adjusted odds ratio [OR] = 1.46), lower father's education (OR = 1.38 and 1.14 for middle school or under and high school of educational level, respectively), breastfeeding duration < 6 months (OR = 1.17), pregnancy maternal smoking (OR = 1.51), obesity (OR = 1.50), overweight (OR = 1.35), several respiratory problems associated with atopy and infection, such as chronic/allergic rhinitis (OR = 1.94), asthma (OR = 1.43), adenotonsillar hypertrophy (OR = 2.17), and chronic otitis media (OR = 1.31), and family history of habitual snoring (OR = 1.70).ConclusionThe prevalence of habitual snoring in Chinese children was similar to that observed in other countries. The potential predisposing factors covered socioeconomic characteristics, environmental exposures, chronic health problems, and family susceptibility. Compared to socioeconomic status and family susceptibility, environmental exposures and chronic health problems had greater impact, indicating childhood habitual snoring could be partly prevented by health promotion and environmental intervention.

Apnea-hypopnea indices and snoring in children diagnosed with ADHD: a matched case-control study

To measure apnea-hypopnea indices and snoring in children diagnosed with attention-deficit hyperactivity disorder (ADHD) in a case-control design. Additionally, the study design allowed us to investigate whether or not methylphenidate had any effect on breathing variables. Twenty-eight children (22 boys) aged 6-12 years meeting diagnostic criteria for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV ADHD were studied together with matched controls. Two nights of polysomnography (PSG) were conducted that included recordings of snoring waveforms. A randomly assigned 48-h on-off medication protocol was used for ADHD children. Control children's recordings were matched for PSG night, but medication was not used. A low apnea-hypopnea index (AHI) threshold of >1 event per hour was used to define sleep-disordered breathing (SDB) because of a clinical relevance in ADHD. Categorical analyses for paired binary data showed no significant differences between control and ADHD children for presence of an AHI >1 or snoring. Variables were extracted from a significantly shorter total sleep time (67 min) on the medication night in children with ADHD. Eight (28%) control and 11 (40%) ADHD children snored >60 dB some time during the night. Methylphenidate had no effect on central apneas, AHI, desaturation events, or any snoring data. Our PSG findings show no strong link between ADHD and SDB although our findings could be limited by a small sample size. Findings from PSG studies in the literature argue both for and against an association between ADHD and SDB. Our results suggest medication is not a factor in the debate.

Experience with adenoidectomy under nasal endoscope for children's snoring diseases

Objective To sum up the experience with adenoidectomy for children's snoring diseases at electrical cutter with suction under nasal endoscopes. Methods 20 cases with children chronic sinusitis, sleep respiratory disorder, heating loss caused by adenoid hypertrophy were operated through nose and month route un-der nasal endoscope in adenoidectomy, with the one year follow-up. Results The adenoid gland was removed completely without of destroying the normal anatomic character. Conclusion The application of double-route nasal endoscope provides a direct and clear view that allows the surgeon to remove adenoid tissue more accurate-ly and effectively with less complications. Key words: Adenoidectomy; Endoscope; Adenoid hypertrophy; Children's snoring diseases