Sleep, Breathing, and Cephalometrics in Older Children and Young Adults: Part I—Normative Values

doi:10.1378/chest.109.3.664

Chest

Volume 109, Issue 3, March 1996, Pages 664-672

https://doi.org/10.1378/chest.109.3.664 Get rights and content

Study objectives

Aims were (1) to provide normative values for sleep and sleep-related breathing variables and physical features (cephalometrics, body mass index [BMI], and tonsillar size) in older children/adolescents and young adults, (2) to describe sex and age group differences, and (3) to evaluate relationships between physical features and sleep-related breathing variables.

Design

Standard polysomnographic variables describing sleep and breathing were measured during a single night. Cephalometric measures were obtained from a standing lateral skull radiograph.

Subjects

Normal, healthy boys (n=23; mean age= 13.3 ± 2.1 years), girls (n=22; mean age=13.8 ± 1.8 years), men (n=23; mean age=22.2 ± 1.5 years), and women (n=24; mean age=22.4 ± 1.8 years) with BMI less than 27 were evaluated.

Results

Sleep variables showed age group and sex differences consistent with published norms. Slow-wave sleep and rapid eye movement (REM) latency declined with age; transient arousals increased with age. Sleep-related breathing variables showed few changes related to age group or sex: small but statistically significant sex differences were found for arterial oxygen saturation nadir (lower in male subjects) and respiration disturbance index in non-REM sleep (greater in male subjects). Differences in cephalometric measures largely reflected normal growth and expected sex differences. No significant relationships between sleep-related breathing variables and physical findings were observed.

Conclusions

These data provide well-controlled normative values for sleep, breathing, and cephalometrics in a group of normal older children, adolescents, and young adults. The data provide useful reference points for patients of these ages in whom sleep apnea is suspected, particularly since such clinical studies are normally based on first-night polysomnography. Furthermore, these values represent developmentally appropriate grouping of the data.

Section snippets

Subjects

Volunteers were 23 boys, 22 girls, 23 young men, and 24 young women from 84 families recruited through flyers and advertisements in local collegiate and city newspapers. The study was approved by the E. P. Bradley Hospital and Rhode Island Hospital Institutional Review Boards, and informed written consent was obtained from each subject (and parents of boys and girls) in accordance with review board procedures. Table 1 presents age values for each group. Seventy-nine subjects were white, 3 were

Physical Findings

BMI (kg/m²) ranged from 15.1 to 26.8 and a significant age effect was found with older subjects having higher BMIs: (F [1,89]=12.1; p<0.001) (Table 1). Boys and girls spanned the Tanner stages (Table 2); young adults were all postpubescent. Tonsillar sizes included the full range of the Brodsky²⁴ scale, though few subjects showed evidence of tonsillar hypertrophy (Table 3).

Sleep Parameters

Mean values, SDs, and minimum and maximum values for each group are presented in Table 4 for sleep measures, in Table 5 for

Discussion

This study provides normative data from a single night of polysomnography, as well as cephalometric values, for older children and young adults with no known risk factors for sleep apnea. The use of a single first night of recording was chosen since this is typical of data obtained in clinical settings. The demonstrated differences as a function of sex and age illustrate the importance of referencing appropriate values for clinical cases. Nevertheless, we also acknowledge the significant

ACKNOWLEDGMENTS

The authors thank Katherine Sharkey, Carol Carlisle, Clayton Bennett, Jr, Jon Dilorio, Pamela Bigler, James K. Wyatt, Cecilia Vieira, John Spencer, and Maximillian Stone for their assistance with this project.

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This work was funded by NIH grant HL44138.

revision accepted September 25.

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Chest

Clinical Investigations: Sleep and BreathingSleep, Breathing, and Cephalometrics in Older Children and Young Adults: Part I—Normative Values

Study objectives

Design

Subjects

Results

Conclusions

Section snippets

Subjects

Physical Findings

Sleep Parameters

Discussion

ACKNOWLEDGMENTS

J Clin Epidemiol

Clin Geriatr Med

J Pediatr

Rev Electroencephalogr Neurophysiol Clin

Chest

Am J Orthod Dentofacial Orthop

Pediatr Clin North Am

Am J Orthod

Respiration during sleep in the aged human

J Gerontol

Incidence of sleep apnea in a presumably healthy working population: a significant relationship with excessive daytime sleepiness

Sleep

Sleep apnea and periodic movements in an aging sample

J Gerontol

Sleep apnea and mortality in an aged cohort

Am J Public Health

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

N Engl J Med

A review of 50 children with obstructive sleep apnea syndrome

Lung

Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations

Pediatrics

Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning

Eur J Pediatr

Clinical Investigations: Sleep and Breathing
Sleep, Breathing, and Cephalometrics in Older Children and Young Adults: Part I—Normative Values