Incidence and Remission of Sleep-Disordered Breathing and Related Symptoms in 6- to 17-Year Old Children—The Tucson Children's Assessment of Sleep Apnea Study

Abstract

Objective-To determine the incidence and remission of sleep disordered breathing in adolescent children.Study design-319 children completed two home polysomnograms approximately 5 years apart. Sleep disordered breathing (SDB) was determined to be present if a child had a respiratory disturbance index ≥ 1 event per hour associated with a ≥3% oxygen desaturation. Subjective symptoms such as witnessed apnea, excessive daytime sleepiness, difficulty initiating and maintaining sleep, and habitual loud snoring were considered present if they occurred frequently or almost always. BMI percentiles were calculated using CDC childhood growth charts adjusted for sex and age.Results-The mean age at assessment was 8.5 years at Baseline and 13.7 years at Follow-up respectively. Incident SDB was more common in boys (OR=3.93, p=.008, CI= 1. 41-10.90). Children with Prevalent SDB were more likely to be boys (OR=2.48, p=.006) and had a greater increase in BMI percentile change (OR 1.01, p=.034). Children with Prevalent SDB also had 3.41 greater odds of developing obesity from Baseline to Follow-up in comparison with children with Prevalent NoSDB.Conclusions-Adolescent boys are more likely to have persistent and incident SDB than girls. Children with prevalent SDB are more likely to have developed obesity. These risks are similar to those observed in adults.Correspondence: James L. Goodwin, PhD, 1501 N. Campbell AHSC 245030, The University of Arizona, Tucson, AZ 85724-5030, Phone: 520-621-5001, FAX: 520-626-6970, jamieg@arc.arizona.edu. Reprint request author : James L. Goodwin Edited by RW and WFB The authors declare no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Sleep disordered breathing (SDB) in children has been associated with a number of physiological, neurocognitive, and behavioral problems. 1-4 Moreover, there is increasing evidence that sleep disordered breathing has an important adverse impact on a child's physical and cognitive health and social development. 1,[5][6][7] Although there are several studies specifying the prevalence of snoring and other sleep related problems in children, 8-10 11, 12 there is little evidence documenting the incidence and remission of symptoms associated with sleep disorders in children, such as witnessed apnea, excessive daytime sleepiness, habitual snoring, and insomnia. [13][14][15] Furthermore, there are no data to date indicating the incidence and remission rates of SDB in a large sample of children using polysomnography as well as identifying factors associated with incidence or remission. This gap in the rese...

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

“…Step 3: recognition of factors predicting long-term persistence of obstructive SDB Literature review a-d) Risk factors for persistence of untreated OSAS were identified in three prospective, cohort studies (class I) [125][126][127].…”

“…Treatment has been shown to be beneficial to children at risk of persistent OSAS (male sex, obese, with persistent tonsillar hypertrophy) (class I and III) [126,127,183]. c) A positive respiratory polygraphy or nocturnal oximetry in the context of clinical symptoms indicative of obstructive SDB has been used as an indication for adenotonsillectomy (class III or IV) [136,162,184].…”

Focus on prevention and treatment of obstructive sleep disordered breathing in childhood

“…In the NANOS study, children with persistent mild OSAS had a significant increase in BMI during the period of dietary modifications [19]. Similarly, in the prospective Tuscon's Children's Assessment of Sleep Apnea Study (TuCASA), untreated participants with persistent OSAS or new-onset disease had increased risk for rising BMI percentile or development of obesity during transition from childhood to adolescence [20]. In a population-based cohort from Hong Kong, persistence of overweight/obesity status over an average period of 4.6 years was a significant predictor of primary snoring progression to OSAS [21].…”

In reference to is polysomnography required prior to tonsillectomy and adenoidectomy for the diagnosis of obstructive sleep apnea versus mild sleep‐disordered breathing in children?

“…10 The routine use of TþA as treatment for symptoms of obstructive sleep-disordered breathing is even more controversial in view of a recent publication on the natural history of pediatric OSA. 11 Over a 5-year period, OSA (AHI 1 episode/hr) and excessive daytime sleepiness resolve spontaneously in approximately 70% and 60%, respectively, of preadolescent children.…”