Pediatric obstructive sleep apnea-related risk factors: A cross-sectional study
DOI:
https://doi.org/10.2340/aos.v83.41385Keywords:
Respiration disorders, sleep apnea syndromes, pediatric, sleep monitoring, obesityAbstract
Objectives: This study investigated obstructive sleep apnea (OSA)-related risk factors in children and adolescents.
Materials and methods: Records of 187 subjects from a private medical clinic were reviewed. Overnight polysomnography recordings and self/parent reports were gathered. Descriptive analysis of sociodemographic, anthropometric, sleep quality and sleep architecture variables and OSA diagnosis were performed. Associations between independent variables and OSA diagnosis were assessed through multivariable logistic regression with robust variance, with a significance level of 5%.
Results: 132 participants were diagnosed with OSA, and 55 were classified as “no OSA” (29.41%). Those overweight or obese were 4.97 times more likely to have OSA than those with normal weight (P = 0.005). Those who reported loud snoring were 2.78 times more likely to have OSA than those who reported mild or moderate snoring intensity. A one-unit increase in arousal index leads to 1.39 increase in the odds ratio (OR) of individuals diagnosed with OSA (P < 0.001), and each one-unit increase in sleep efficiency leads to 1.09 higher odds of not having OSA (P = 0.002).
Conclusions: Significantly increased OSA-related risk factors among overweight/obese children and adolescents and among those who had a parental/self-report of loud snoring were found.
Downloads
References
Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016;47:69-94. https://doi.org/10.1183/13993003.00385-2015 DOI: https://doi.org/10.1183/13993003.00385-2015
Li AM, So HK, Au CT, Albert M, Ho C, Lau J, et al. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax. 2010;65:991-997. https://doi.org/10.1136/thx.2010.134858 DOI: https://doi.org/10.1136/thx.2010.134858
Brunetti L, Rana S, Lospalluti ML, Pietrafesa A, Francavilla R, Fanelli M, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. Chest. 2001;120:1930-1935. https://doi.org/10.1378/chest.120.6.1930 DOI: https://doi.org/10.1378/chest.120.6.1930
Tsukada E, Kitamura S, Enomoto M, Moriwaki A, Kamio Y, Asada T, et al. Prevalence of childhood obstructive sleep apnea syndrome and its role in daytime sleepiness. PLoS One. 2018;13:e0204409. https://doi.org/10.1371/journal.pone.0204409 DOI: https://doi.org/10.1371/journal.pone.0204409
Kitamura T, Miyazaki S, Kadotani H, Suzuki H, Kanemura T, Komada I, et al. Prevalence of obstructive sleep apnea syndrome in Japanese elementary school children aged 6-8 years. Sleep Breath. 2014;18:359-366. https://doi.org/10.1007/s11325-013-0893-5 DOI: https://doi.org/10.1007/s11325-013-0893-5
Andersen IG, Holm JC, Homoe P. Obstructive sleep apnea in children and adolescents with and without obesity. Eur Arch Otorhinolaryngol. 2019;276:871–8. https://doi.org/10.1007/s00405-019-05290-2 DOI: https://doi.org/10.1007/s00405-019-05290-2
Bin-Hasan S, Katz S, Nugent Z, Nehme J, Lu Z, Khayat A, et al. Prevalence of obstructive sleep apnea among obese toddlers and preschool children. Sleep Breath. 2018;22:511-515. https://doi.org/10.1007/s11325-017-1576-4 DOI: https://doi.org/10.1007/s11325-017-1576-4
Spilsbury JC, Storfer-Isser A, Rosen CL, Redline S. Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence. Sleep. 2015;38:23–9. https://doi.org/10.5665/sleep.4318 DOI: https://doi.org/10.5665/sleep.4318
Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:e714-755. https://doi.org/10.1542/peds.2012-1672 DOI: https://doi.org/10.1542/peds.2012-1672
American Academy of Sleep Medicine. International classification of sleep disorders. Darien, IL: American Academy of Sleep Medicine; 2014.
American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:704–12. https://doi.org/10.1542/peds.109.4.704 DOI: https://doi.org/10.1542/peds.109.4.704
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495-1499. https://doi.org/10.1016/j.ijsu.2014.07.013 DOI: https://doi.org/10.1016/j.ijsu.2014.07.013
World Health Organization. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76–85. https://doi.org/10.1111/j.1651-2227.2006.tb02378.x DOI: https://doi.org/10.1111/j.1651-2227.2006.tb02378.x
Owens JA, Spirito A, McGuinn M. The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep. 2000;23:1043–52. DOI: https://doi.org/10.1093/sleep/23.8.1d
Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus C, Vaughn BV. The AASM manual for the scoring of sleep and associated events. Rules, Terminology and Technical Specifications. Darien, IL: American Academy of Sleep Medicine; 2012. p. 176.
Stowe RC, Afolabi-Brown O. Pediatric polysomnography-A review of indications, technical aspects, and interpretation. Paediatr Respir Rev. 2020;34:9–17. https://doi.org/10.1016/j.prrv.2019.09.009 DOI: https://doi.org/10.1016/j.prrv.2019.09.009
Lobbezoo F, Ahlberg J, Raphael KG, Wetselaar P, Glaros AG, Kato T, et al. International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil. 2018;45:837-844. https://doi.org/10.1111/joor.12663 DOI: https://doi.org/10.1111/joor.12663
Shrivastava D, Jung S, Saadat M, Sirohi R, Crewson K. How to interpret the results of a sleep study. J Community Hosp Intern Med Perspect. 2014;4:24983. https://doi.org/10.3402/jchimp.v4.24983 DOI: https://doi.org/10.3402/jchimp.v4.24983
Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, et al. National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health. 2017;3:6-19. https://doi.org/10.1016/j.sleh.2016.11.006 DOI: https://doi.org/10.1016/j.sleh.2016.11.006
Durdik P, Sujanska A, Suroviakova S, Evangelisti M, Banovcin P, Villa MP. Sleep architecture in children with common phenotype of obstructive sleep apnea. J Clin Sleep Med. 2018;14:9–14. https://doi.org/10.5664/jcsm.6868 DOI: https://doi.org/10.5664/jcsm.6868
Selvadurai S, Voutsas G, Propst EJ, Wolter NE, Narang I. Obstructive sleep apnea in children aged 3 years and younger: rate and risk factors. Paediatr Child Health. 2020;25:432–8. https://doi.org/10.1093/pch/pxz097 DOI: https://doi.org/10.1093/pch/pxz097
Verhulst SL, Franckx H, Van Gaal L, De Backer W, Desager K. The effect of weight loss on sleep-disordered breathing in obese teenagers. Obesity (Silver Spring). 2009;17:1178–83. https://doi.org/10.1038/oby.2008.673 DOI: https://doi.org/10.1038/oby.2008.673
Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:242–52. https://doi.org/10.1513/pats.200708-135mg DOI: https://doi.org/10.1513/pats.200708-135MG
Roche J, Isacco L, Masurier J, Pereira B, Mougin F, Chaput JP, et al. Are obstructive sleep apnea and sleep improved in response to multidisciplinary weight loss interventions in youth with obesity? A systematic review and meta-analysis. Int J Obes (Lond). 2020;44:753-770. https://doi.org/10.1038/s41366-019-0497-7 DOI: https://doi.org/10.1038/s41366-019-0497-7
Yan XH, Zhao Y, Wang J, Shen T, Yang W, Qiao Y, et al. Associations among sleep symptoms, physical examination, and polysomnographic findings in children with obstructive sleep apnea. Eur Arch Otorhinolaryngol. 2020;277:623-630. https://doi.org/10.1007/s00405-019-05719-8 DOI: https://doi.org/10.1007/s00405-019-05719-8
Kim SW, Taranto-Montemurro L. When do gender differences begin in obstructive sleep apnea patients? J Thorac Dis. 2019;11:S1147–9. https://doi.org/10.21037/jtd.2019.04.37 DOI: https://doi.org/10.21037/jtd.2019.04.37
Lam YY, Chan EY, Ng DK, Chan CH, Cheung JMY, Leunget SY, al. The correlation among obesity, apnea-hypopnea index, and tonsil size in children. Chest. 2006;130:1751-1756. https://doi.org/10.1378/chest.130.6.1751 DOI: https://doi.org/10.1378/chest.130.6.1751
Dong Z, Xu X, Wang C, Cartledge S, Maddison R, Islam SMS. Association of overweight and obesity with obstructive sleep apnoea: a systematic review and meta-analysis. Obes Med. 2020;17:100185. DOI: https://doi.org/10.1016/j.obmed.2020.100185
Arens R, Marcus CL. Pathophysiology of upper airway obstruction: a developmental perspective. Sleep. 2004;27:997–1019. https://doi.org/10.1093/sleep/27.5.997 DOI: https://doi.org/10.1093/sleep/27.5.997
Keefe KR, Patel PN, Levi JR. The shifting relationship between weight and pediatric obstructive sleep apnea: a historical review. Laryngoscope. 2019;129:2414–9. https://doi.org/10.1002/lary.27606 DOI: https://doi.org/10.1002/lary.27606
Castroflorio T, Bargellini A, Rossini G, Cugliari G, Deregibus A. Sleep bruxism in adolescents: a systematic literature review of related risk factors. Eur J Orthod. 2017;39:61–8. https://doi.org/10.1093/ejo/cjw012 DOI: https://doi.org/10.1093/ejo/cjw012
Ferreira NM, Dos Santos JF, dos Santos MB, Marchini L. Sleep bruxism associated with obstructive sleep apnea syndrome in children. Cranio. 2015;33:251–5. https://doi.org/10.1080/08869634.2015.1097299 DOI: https://doi.org/10.1080/08869634.2015.1097299
Tachibana M, Kato T, Kato-Nishimura K, Matsuzawa S, Mohri I, Taniike M. Associations of sleep bruxism with age, sleep apnea, and daytime problematic behaviors in children. Oral Dis. 2016;22:557–65. https://doi.org/10.1111/odi.12492 DOI: https://doi.org/10.1111/odi.12492
Manfredini D, Guarda-Nardini L, Marchese-Ragona R, Lobbezoo F. Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion. Sleep Breath. 2015;19:1459–65. https://doi.org/10.1007/s11325-015-1163-5 DOI: https://doi.org/10.1007/s11325-015-1163-5
De Luca Canto G, Singh V, Gozal D, Major PW, Flores-Mir C. Sleep bruxism and sleep-disordered breathing: a systematic review. J Oral Facial Pain Headache. 2014;28:299–305. https://doi.org/10.11607/ofph.1294 DOI: https://doi.org/10.11607/ofph.1294
Walter LM, Nixon GM, Davey MJ, O’Driscoll DM, Trinder J, Horne RS. Sleep disturbance in pre-school children with obstructive sleep apnoea syndrome. Sleep Med. 2011;12:880–6. https://doi.org/10.1016/j.sleep.2011.07.007 DOI: https://doi.org/10.1016/j.sleep.2011.07.007
Wise MS, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, et al. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep. 2011;34:389-398AW. https://doi.org/10.1093/sleep/34.3.389 DOI: https://doi.org/10.1093/sleep/34.3.389
Published
Issue
Section
License
Copyright (c) 2024 Júlia Machado Saporiti, Deborah Castagno, Clarissa Delpizzo Castagno, Maria Perpétua Mota Freitas, Marília Leão Goettems, Noéli Boscato
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes high quality original research papers as well as critical reviews relevant on diseases of the oral cavity, their treatment, epidemiology and associated biomaterials and their development.
