Characteristics and risk factors of snoring and the prevalence of suspected obstructive sleep apnea in children
Keywords:
snoring, obstructive sleep apnea, risk factors, prevalence
Abstract
Background Snoring as a consequence of upper airway obstruc-tion is common in children. Snoring can be considered as normal,
but might also reflect a disease such as obstructive sleep apnea
(OSA), which is associated with serious morbidities. In Indonesia,
data on the characteristics and risk factors of snoring and obstruc-
tive sleep apnea is limited
Objectives The aims of this study were to find out the character-
istics and risk factors of snoring in children and to determine the
prevalence of suspected OSA in snoring children.
Methods A cross-sectional study was carried out on children aged
5-13 years using parental questionnaires scored according to the
Brouilette formula. All children underwent physical examination for
weight, height and tonsil size. Adenoid radiology was performed
on part of the samples.
Results Of the 917 questionnaires distributed, only 658 were com-
pleted. The ratio of boys to girls was equal. Obesity was detected
in 18.3% of children, among whom 54.2% snored. Obese children
were 2.1 times more likely to snore. Besides obesity, rhinitis and
atopy were found to be associated with snoring (PR= , 95%CI ;
and PR= , 95%CI ; respectively). Asthma and tonsil hypertrophy
were shown not to be predisposing factors of snoring. Children
with adenoid hypertrophy were 1.8 times more likely to snore ha-
bitually. The prevalence of snoring and suspected OSA in children
aged 5-13 years were 31.6% and 5.9%, respectively.
Conclusion Risk factors of snoring were obesity, adenoid hyper-
trophy, atopy and rhinitis. Prevalence of snoring in children age 5-
13 years was 31.6% and that of suspected OSA cases was 5.9%.
References
1. Kiely JL, McNicholas WT. Overview and historical as-
pects of breathing disorders during sleep. In:
McNicholas WT, editor. Respiratory disorders during
sleep. London: European Respiratory Society Journals
Ltd; 1998. p. 1-8.
2. Bar A, Tarasiuk A, Segar Y, Phillip M, Tal A. The ef-
fect of adenotonsilectomy on serum insulin like growth
factor-I and growth in children with obstructive sleep
apnea syndrome. J Pediatr 1999;135:76-80.
3. Corbo GM, Forastiere FF, Agabiti N, Istelli R, Dell’Arco
V, Peruci CA. Snoring in 9- to 15-year-old children:
risk factors and clinical relevance. Am Acad Pediatr
2001;108:1149-53.
4. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Gra-
ham G. Risk factors for sleep disordered breathing in chil-
dren. Associations with obesity, race and respiratory prob-
lems. Am J Respir Crit Care Med 1999;159:1527-32.
5. Kasey K, Nelson B, Kushida C, Riley R, Adorneto
B, Guileminaut C. A comparison of Asian and white
patients with OSA syndrome. Laryngoscope
1999;109:1937-40.
6. Caroll JL, Mc Colley SA, Marcus CL, Curtis S,
Loughlin GM. Inability of clinical history to distinguish
primary snoring from obstructive sleep apnea syndrome
in children. Chest 1995;108:610-8.
7. Guilleminault C, Tilkian A, Demant W. The sleep
apnea syndromes. Citated by Dyson MC, Beckerman
RC. Obstructive sleep apnea syndrome. In: Hilman
BC, editor. Pediatric respiratory disease diagnosis and
treatment. Lousiana: WB Saunders Company; 1993.
p. 563-73.
8. Marcus C, Hamer A, Loughin GM. Natural history of
primary snoring in children. Pediatr Pulmonol
1998;26:6-11.
9. Schechter MS. Technical report: Diagnosis and man-
agement of childhood obstructive sleep apnea syn-
drome. Pediatr 2002;109:1-20.
10. Brouillette R, Hanson D, David R. A diagnostic ap-
proach to suspected obstructive sleep apnea in chil-
dren. J Pediatr 1984;105:10-4.
11. Teculescu D, Hanhart B, Aubry C. Who are the occa-
sional snorers? Am College of Chest Phys 2002;122.
12. Cohen D, Konak S. The evaluation of radiographs of
the nasopharynx. [abstract] Clin Otolaryngol
1985;10:73-8.
13. National Center for Chronic Disease Prevention and
Health Promotion. BMI for children and teens.
Avaiable at: URL: http://www.cdc.gov/hccdphp/dnpa/
bmi/bmi-for-age.htm
14. Ferreira AM, Clemente V, Gozal D, Gomes A, Pissarra C,
Cesar H, et al. Snoring in Portuguese primary school chil-
dren. Pediatrics 2000;106.
15. Anuntaseree W, Rookkapan K, Kuasirikuit S,
Thongsuksai P. Snoring and obstructive sleep apnea in
Thai school-age children: prevalence and predispos-
ing factors. Pediatr Pulmonol 2001;32:222-7.
16. Corbo GM, Fuciarelli F, Foress A, Benedetto F. Snor-
ing in children: association with respiratory symptoms
and passive smoking. Br Med J 1989;299:1491-4.
17. Gislason T, Benediktsdottir B. Snoring, apneic episodes
and nocturnal hypoxemia among childern 6 months
to 6 years old. An epidemiologic study of lower limit of
prevalence. Chest 1995;107:963-66.
18. Young T, Peppard PE, Gottlieb DJ. Epidemiology of ob-
structive sleep apnea. A population health perspec-
tive. Am J Respir Crit Care Med 2002;165:1217-38.
19. Deegan PC, McNicholas WT. Pathophysiology of ob-
structive sleep apnoea. In: McNicholas WT, editor. Res-
piratory disorders during sleep. London: European Res-
piratory Society Journals Ltd; 1998. p. 28-62.
20. Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep disturbance &
behavior in 4 – 5 year olds. Arch Dis Child 1993; 68:360-6.
21. Teculescu DB, Caillier I,Perin P, Rbestock E, Rauch A.
Snoring in French preschool children. Pediatr
Pulmonol 1992;13:239-244.
22. Nieminen P, Tolonen U, Lopponen H. Snoring and
obstructive sleep apnea in children, a 6- month fol-
low-up study. Arch Otolaryngol Head Neck Surg
2000;126:481-6.
23. Chay M, Goh A, Abisheganaden J, Tang J, Lim WH, Chan
YH, et al. Obstructive sleep apnea syndrome in obese
Singapore children. Pediatr Pulmonol 2000;29:284-90.
24. Mortimore IL, Marshal I, Waith PK, Sellar RJ, Douglas NJ.
Neck and total body fat deposition in non obese and obese
patients with sleep apnea compared with that in control
subject. Am J Respir Crit Care Med 1998;157:280-3
25. Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR,
Loughlin GM. Evaluation of pulmonary function and
polysomnography in obese children and adolescent.
Pediatr Pulmonol 1996; 21:176-83.
26. Davies RJ, Ali NJ, Stradling JR. Neck circumference
and other clinical features in the diagnosis of the ob-
structive leep apneoea syndrome. [abstract] Thorax
1992;47:101-5.
27. Mallory GB, Fiser DH, Jackson R. Sleep-associated
breathing disorders in morbidly obese children and ado-
lescents. J Pediatr 1989;115:892-7.
28. Lu L, Peat J, Sullivan C. The prevalence of snoring in
preschool children and its association with night cough
and asthma. [abstract] Proceedings of the 6th World
Sleep Congress; 2000 Mar 12-15; Sydney, Australia.
Sydney: World Sleep Society; 2000.
pects of breathing disorders during sleep. In:
McNicholas WT, editor. Respiratory disorders during
sleep. London: European Respiratory Society Journals
Ltd; 1998. p. 1-8.
2. Bar A, Tarasiuk A, Segar Y, Phillip M, Tal A. The ef-
fect of adenotonsilectomy on serum insulin like growth
factor-I and growth in children with obstructive sleep
apnea syndrome. J Pediatr 1999;135:76-80.
3. Corbo GM, Forastiere FF, Agabiti N, Istelli R, Dell’Arco
V, Peruci CA. Snoring in 9- to 15-year-old children:
risk factors and clinical relevance. Am Acad Pediatr
2001;108:1149-53.
4. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Gra-
ham G. Risk factors for sleep disordered breathing in chil-
dren. Associations with obesity, race and respiratory prob-
lems. Am J Respir Crit Care Med 1999;159:1527-32.
5. Kasey K, Nelson B, Kushida C, Riley R, Adorneto
B, Guileminaut C. A comparison of Asian and white
patients with OSA syndrome. Laryngoscope
1999;109:1937-40.
6. Caroll JL, Mc Colley SA, Marcus CL, Curtis S,
Loughlin GM. Inability of clinical history to distinguish
primary snoring from obstructive sleep apnea syndrome
in children. Chest 1995;108:610-8.
7. Guilleminault C, Tilkian A, Demant W. The sleep
apnea syndromes. Citated by Dyson MC, Beckerman
RC. Obstructive sleep apnea syndrome. In: Hilman
BC, editor. Pediatric respiratory disease diagnosis and
treatment. Lousiana: WB Saunders Company; 1993.
p. 563-73.
8. Marcus C, Hamer A, Loughin GM. Natural history of
primary snoring in children. Pediatr Pulmonol
1998;26:6-11.
9. Schechter MS. Technical report: Diagnosis and man-
agement of childhood obstructive sleep apnea syn-
drome. Pediatr 2002;109:1-20.
10. Brouillette R, Hanson D, David R. A diagnostic ap-
proach to suspected obstructive sleep apnea in chil-
dren. J Pediatr 1984;105:10-4.
11. Teculescu D, Hanhart B, Aubry C. Who are the occa-
sional snorers? Am College of Chest Phys 2002;122.
12. Cohen D, Konak S. The evaluation of radiographs of
the nasopharynx. [abstract] Clin Otolaryngol
1985;10:73-8.
13. National Center for Chronic Disease Prevention and
Health Promotion. BMI for children and teens.
Avaiable at: URL: http://www.cdc.gov/hccdphp/dnpa/
bmi/bmi-for-age.htm
14. Ferreira AM, Clemente V, Gozal D, Gomes A, Pissarra C,
Cesar H, et al. Snoring in Portuguese primary school chil-
dren. Pediatrics 2000;106.
15. Anuntaseree W, Rookkapan K, Kuasirikuit S,
Thongsuksai P. Snoring and obstructive sleep apnea in
Thai school-age children: prevalence and predispos-
ing factors. Pediatr Pulmonol 2001;32:222-7.
16. Corbo GM, Fuciarelli F, Foress A, Benedetto F. Snor-
ing in children: association with respiratory symptoms
and passive smoking. Br Med J 1989;299:1491-4.
17. Gislason T, Benediktsdottir B. Snoring, apneic episodes
and nocturnal hypoxemia among childern 6 months
to 6 years old. An epidemiologic study of lower limit of
prevalence. Chest 1995;107:963-66.
18. Young T, Peppard PE, Gottlieb DJ. Epidemiology of ob-
structive sleep apnea. A population health perspec-
tive. Am J Respir Crit Care Med 2002;165:1217-38.
19. Deegan PC, McNicholas WT. Pathophysiology of ob-
structive sleep apnoea. In: McNicholas WT, editor. Res-
piratory disorders during sleep. London: European Res-
piratory Society Journals Ltd; 1998. p. 28-62.
20. Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep disturbance &
behavior in 4 – 5 year olds. Arch Dis Child 1993; 68:360-6.
21. Teculescu DB, Caillier I,Perin P, Rbestock E, Rauch A.
Snoring in French preschool children. Pediatr
Pulmonol 1992;13:239-244.
22. Nieminen P, Tolonen U, Lopponen H. Snoring and
obstructive sleep apnea in children, a 6- month fol-
low-up study. Arch Otolaryngol Head Neck Surg
2000;126:481-6.
23. Chay M, Goh A, Abisheganaden J, Tang J, Lim WH, Chan
YH, et al. Obstructive sleep apnea syndrome in obese
Singapore children. Pediatr Pulmonol 2000;29:284-90.
24. Mortimore IL, Marshal I, Waith PK, Sellar RJ, Douglas NJ.
Neck and total body fat deposition in non obese and obese
patients with sleep apnea compared with that in control
subject. Am J Respir Crit Care Med 1998;157:280-3
25. Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR,
Loughlin GM. Evaluation of pulmonary function and
polysomnography in obese children and adolescent.
Pediatr Pulmonol 1996; 21:176-83.
26. Davies RJ, Ali NJ, Stradling JR. Neck circumference
and other clinical features in the diagnosis of the ob-
structive leep apneoea syndrome. [abstract] Thorax
1992;47:101-5.
27. Mallory GB, Fiser DH, Jackson R. Sleep-associated
breathing disorders in morbidly obese children and ado-
lescents. J Pediatr 1989;115:892-7.
28. Lu L, Peat J, Sullivan C. The prevalence of snoring in
preschool children and its association with night cough
and asthma. [abstract] Proceedings of the 6th World
Sleep Congress; 2000 Mar 12-15; Sydney, Australia.
Sydney: World Sleep Society; 2000.
Published
2016-10-10
How to Cite
1.
Supriyatno B, Deviani R, Tumbelaka A, Ifran E, Rahajoe N. Characteristics and risk factors of snoring and the prevalence of suspected obstructive sleep apnea in children. PI [Internet]. 10Oct.2016 [cited 22Nov.2024];45(1):40-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/796
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Received 2016-10-05
Accepted 2016-10-05
Published 2016-10-10
Accepted 2016-10-05
Published 2016-10-10
