Snoring, Apneic Episodes, and Nocturnal Hypoxemia Among Children 6 Months to 6 Years Old: An Epidemiologic Study of Lower Limit of Prevalence

doi:10.1378/chest.107.4.963

Chest

Volume 107, Issue 4, April 1995, Pages 963-966

https://doi.org/10.1378/chest.107.4.963 Get rights and content

Study objective

To identify a lower limit of the prevalence of sleep-related breathing disturbances among preschool children.

Design

A cross-sectional epidemiologic study in two stages, first by questionnaires and second by whole-night investigation of children symptomatic of the sleep apnea syndrome.

Setting

Gardabaer, a small town, 10 km south of Reykjavik, Iceland.

Participants

All children in Gardabaer, 6 months to 6 years old (n=555).

Measurements

Symptom score estimated by questionnaire and respiratory events based on overnight oximetry, thermistors, and a static charge sensitive bed.

Results

The response rate was 81.8%. Snoring was reported as often or very often among 14 (3.2%) and occasionally by 73 (16.7%). Apneic episodes were reported often or very often among seven (1.6%). Altogether 18 children were highly suspected of the sleep apnea syndrome because of habitual snoring or apneic episodes. The girls (n=9) were older than the boys (mean age: 46 ± 21 months vs 20 ± 12 months, p<0.001). Eventually 11 children came for a whole-night investigation and 8 of them showed more than three respiratory events per hour of sleep, associated with ≥4% oxygen desaturation. The lower limit of the sleep apnea syndrome prevalence among these children was thus 2.9% (SE, 0.5%).

Conclusions

Among children, symptoms such as snoring and apneic episodes are reported relatively seldom, but a high proportion of the children with these symptoms have hypoxic respiratory events.

Section snippets

Material and Methods

This study on sleep disturbances was part of a larger epidemiologic survey on the interrelationship between upper respiratory tract infections (URTI), age, gender, daily life, social surroundings, and sleep.¹¹ All children aged 6 months to 6 years old (n=555) living in Gardabaer, a small town with 6,843 inhabitants, 10 km south of the capital city Reykjavik, Iceland, were included in this study.
After a pilot study, we constructed a questionnaire consisting of four major parts concerning the

Results

After two reminders, 454 (81.8%) questionnaires were obtained for further study.¹¹ There were 203 boys and 251 girls (Table 1). Adenoidectomy was reported by 43 boys (22.5%) and 34 girls (14.4%) (p<0.05). Only 6 children had undergone tonsillectomy, all but 1 adenoidectomy as well.

Discussion

The survey participation rate was almost 82% and the responders had the same age distribution as the study population.¹¹ There were no systematic differences in answers to the first, second, and third letters concerning age, gender, or the prevalence of sleep-related symptoms. It is therefore unlikely that the responders differ systematically from the responders.

The prevalence of SAS symptoms is much lower among children than adults.1, 2, 3 However, the lower limit of the SAS prevalence (2.9%)

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Electrocardiographic signs of pulmonary hypertension in children who snore
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: revision accepted September 2.

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Chest

Clinical Investigations: Sleep and BreathingSnoring, Apneic Episodes, and Nocturnal Hypoxemia Among Children 6 Months to 6 Years Old: An Epidemiologic Study of Lower Limit of Prevalence

Study objective

Design

Setting

Participants

Measurements

Results

Conclusions

Section snippets

Material and Methods

Results

Discussion

J Clin Epidemiol

Chest

Otolaryngol Clin North Am

Lancet

The occurrence of sleep-disordered breathing among middle-aged adults

N Engl J Med

Chronic snoring and obstructive sleep apnea syndrome in children

Lung

Tonsillar hyperplasia in children: a cause of obstructive sleep apnea, CO2 retention, and retarded growth

Arch Otolaryngol

Electrocardiographic signs of pulmonary hypertension in children who snore

BMJ

Clinical Investigations: Sleep and Breathing
Snoring, Apneic Episodes, and Nocturnal Hypoxemia Among Children 6 Months to 6 Years Old: An Epidemiologic Study of Lower Limit of Prevalence

Tonsillar hyperplasia in children: a cause of obstructive sleep apnea, CO₂ retention, and retarded growth