Snoring and atopic disease: a strong association

The prevalence and factors associated with snoring and habitual snoring in Asian children are largely unknown. Our objectives were to evaluate the prevalence and factors associated with snoring and habitual snoring in preschool and primary school children in Singapore. A self-response questionnaire on snoring was administered to parents of children aged 4-7 years in randomly selected preschools and primary schools in Singapore. The overall response rate was 91.3% (nt = 11,114). Snoring and habitual snoring were reported in 28.1% and in 6.0% of the children, respectively. On multivariate logistic regression analysis, snoring was significantly associated with male gender, race, atopy (asthma, allergic rhinitis, or atopic dermatitis), maternal atopy (allergic rhinitis or atopic dermatitis), maternal smoking, and breastfeeding. Habitual snoring was significantly associated with obesity (odds ratio (OR), 3.75; 95% confidence interval (CI), 1.67-8.42), allergic rhinitis (OR, 2.90; 95% CI, 2.06-4.08), atopic dermatitis (OR, 1.80; 95% CI, 1.28-2.54), maternal smoking (OR, 2.22; 95% CI, 1.09-4.53), and breastfeeding (OR, 1.49; 95% CI, 1.11-1.98). Atopy was the strongest risk factor for habitual snoring, and the effect was cumulative. The odds ratio of a child with all three atopic diseases (asthma, allergic rhinitis, and atopic dermatitis) to have habitual snoring was 7.45 (95% CI, 3.48-15.97). In conclusion, snoring and habitual snoring are common in Asian children. Atopy is strongly associated with snoring and habitual snoring. We suggest that children who are significantly atopic receive additional attention during screening for snoring, habitual snoring, and other features of obstructive sleep apnea syndrome.