Chest
Volume 120, Issue 6, December 2001, Pages 1930-1935
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Clinical Investigations
SLEEP
Prevalence of Obstructive Sleep Apnea Syndrome in a Cohort of 1,207 Children of Southern Italy

https://doi.org/10.1378/chest.120.6.1930Get rights and content

Study objective

To determine the prevalence of sleep-related breathing disturbances in a large cohort of school-aged and preschool-aged children of Southern Italy.

Design and setting

This cross-sectional prevalence study was designed in two phases: a screening phase aimed to identify symptomatic children from a cohort of 1,207 by a self-administered questionnaire, and an instrumental phase for the definition of sleep-related disorders.

Patients and methods

One thousand two hundred seven children were screened by a self-administered questionnaire. There were 612 female children (51%) and 595 male children (mean age, 7.3 years; range, 3 to 11 years). According to answers, children were classified in three groups: nonsnorers, occasional snorers, and habitual snorers. All habitual snoring children underwent a polysomnographic home evaluation, and those with an oxygen desaturation index > 2 were considered for nocturnal polygraphic monitoring (NPM). Children with an apnea/hypopnea index > 3 received a diagnosis of obstructive sleep apnea syndrome (OSAS).

Results

A total of 895 questionnaires (74.2%) were returned and scored; 710 children (79.3%) were identified as nonsnorers, 141 children (15.8%) were identified as occasional snorers, and 44 children (4.9%) were identified as habitual snorers. The percentage of male children who were habitual snorers was higher than the percentage of female children who were habitual snorers (6.1% vs 3.7%, respectively; p < 0.09). OSAS was diagnosed in nine children by NPM.

Conclusion

The lower limit of prevalence of OSAS in childhood is 1% (95% confidence interval[CI], 0.8 to 1.2). If we add the five children who underwent adenoidectomy and/or tonsillectomy because of worsening clinical condition and the two children who were shown to have evidence of OSAS on domiciliary oximetry, then the prevalence is 1.8% (higher limit of prevalence; 95% CI, 1.6 to 2.0).

Section snippets

Materials and Methods

This study is a part of a large epidemiologic survey on the definition of sleep-related disorders in childhood in southern Italy, and it is aimed to evaluate the prevalence of OSAS. A sample of 1,207 children living in Molfetta, a small town with 65,000 inhabitants 30 km north of Bari, was screened in this study. The school population of this town consists of 4,867 children (1,530 in nursery and 3,337 in primary schools). The student population was stratified by schools and by year of course;

Analysis of Questionnaires

Eight hundred ninety-five fully completed questionnaires were returned and scored (895 of 1,207 questionnaires; 74.2%). One hundred forty-three questionnaires (16%) were returned after one or two phone contacts by us; we believe that the 25% who did not respond represents the group of families that are not sensitive to the problem and therefore not are likely to have children suffering from OSAS. A comparison of demographic data of responders and nonresponders revealed no significant difference

Discussion

The present study, to our knowledge the first in a large cohort of Italian children, shows an overall prevalence of sleep breathing disorders of 4.9% for habitual snoring and of 1.8% for OSAS. Interestingly, troubled sleep, nocturnal sweating, and oral breathing were significantly more frequent than other symptoms in patients with OSAS.

The prevalence of sleep breathing disorders varies widely, ranging from 3.2% to 12.1% for habitual snoring and from 1.1 to 2.9% for OSAS.45 Several factors play

Conclusion

Our study has shown an overall prevalence of OSAS of 1.8%. However, the lack of a consensus for the diagnosis of OSAS in children and the impossibility to use the adult guidelines in the pediatric contest2 make it difficult to assess the prevalence of this disorder in childhood. Despite these methodologic and practical difficulties, it is necessary to sensitize the pediatrician toward the problem of sleep-related breathing disorders in order to identify children at risk and to offer a proper

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