DOI QR코드

DOI QR Code

A Study on Factors Related to Sleep Disordered Breathing in Children

어린이의 수면 호흡 장애 관련 위험인자

  • Nawoon, Kim (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Daewoo, Lee (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Jaegon, Kim (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Changkeun, Lee (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Yeonmi, Yang (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University)
  • 김나운 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소) ;
  • 이대우 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소) ;
  • 김재곤 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소) ;
  • 이창근 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소) ;
  • 양연미 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소)
  • Received : 2021.12.24
  • Accepted : 2022.02.24
  • Published : 2022.05.31

Abstract

The aim of this study was to investigate the risk factors associated with sleep disordered breathing (SDB) by comparing intraoral factors, body mass index (BMI), and medical history with pediatric sleep questionnaire (PSQ) findings. Seven hundred eighty-seven subjects aged between 7 to 11 years old were included. Their caregivers were asked to complete questionnaires. Oral manifestations including Angle's classification, overjet, and Brodsky tonsil grade were examined. Children with PSQ scores of more than 0.33 points were classified into the SDB high-risk group. Among the 787 subjects, 34 (4.3%) were classified into the SDB high-risk group. Children with allergic rhinitis, atopic dermatitis, excessive overjet, or large tonsil size had a significantly higher risk for SDB versus those without. Also, there was a significant difference in SDB risk according to BMI status. Gender, gestational age, breastfeeding, and Angle's classification were not associated with SDB. Children at high risk for SDB were predisposed to tonsillar hypertrophy, allergic rhinitis, obesity, and atopic dermatitis. Children with these factors could be candidates for early intervention to prevent the progression of SDB.

이 연구의 목적은 소아 수면 설문지(PSQ)를 활용하여, 구강 내 소견, 체질량 지수(BMI) 및 병력과 비교함으로써 수면 호흡 장애(SDB)와 관련된 잠재적 위험 요인을 조사하는 것이다. 만 7세에서 11세 사이의 787명의 어린이가 포함되었으며, 어린이의 보호자는 설문지를 작성하였다. Angle의 분류, 수평피개 및 Brodsky 편도 등급을 포함한 구강 증상을 조사하였다. 이중 PSQ 점수가 0.33점 이상인 대상은 SDB 고위험군으로 분류되었다. 787명 중 34명(4.3%)이 SDB 고위험군으로 분류되었다. 알레르기성 비염, 아토피성 피부염, 과도한 수평피개, 편도 비대를 가진 어린이는 그렇지 않은 어린이보다 SDB 위험이 훨씬 더 높았다. 또한 BMI 상태에 따라 SDB 위험도에 유의한 차이가 있었다. 성별, 재태 연령, 모유 수유 및 Angle의 분류는 SDB와 관련이 없었다. 이 연구에서 SDB 고위험군의 어린이는 4.3%로 나타났으며, 예측인자로는 편도 비대, 알레르기성 비염, 비만 및 아토피성 피부염이 있었다. 이러한 예측인자를 가진 어린이는 SDB가 발생할 위험이 높고 조기개입이 필요한 대상이 될 수 있다.

Keywords

References

  1. Panossian L, Daley J : Sleep-disordered breathing. Continuum, 19:86-103, 2013.  https://doi.org/10.1212/01.CON.0000427211.98305.c6
  2. Chang SJ, Chae KY : Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr, 53:863-871, 2010.  https://doi.org/10.3345/kjp.2010.53.10.863
  3. Tan HL, Gozal D, Kheirandish-Gozal L : Obstructive sleep apnea in children: a critical update. Nat Sci Sleep, 25:109-123, 2013. 
  4. American Academy of Pediatrics : Clinical practice guideline. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 130:576-684, 2012.  https://doi.org/10.1542/peds.2012-1671
  5. Rohra AK Jr, Demko CA, Palomo JM, et al. : Sleep disordered breathing in children seeking orthodontic care. Am J Orthod Dentofacial Orthop, 154:65-71, 2018.  https://doi.org/10.1016/j.ajodo.2017.11.027
  6. Chervin RD, Hedger K, Dillon JE, Pituch KJ : Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med, 1:21-32, 2000.  https://doi.org/10.1016/S1389-9457(99)00009-X
  7. Lumeng JC, Chervin RD : Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc, 5:242-252, 2008.  https://doi.org/10.1513/pats.200708-135MG
  8. Shin C, Joo SJ, Kim JK, Kim T : Prevalence and correlates of habitual snoring in high school students. Chest, 124:1709-1715, 2003.  https://doi.org/10.1378/chest.124.5.1709
  9. Schwengel DA, Dalesio NM, Stierer TL : Pediatric obstructive sleep apnea. Anesthesiol Clin, 32:237-261, 2014.  https://doi.org/10.1016/j.anclin.2013.10.012
  10. Ikavalko T, Narhi M, Pahkala R, et al. : Predictors of sleep disordered breathing in children: the PANIC study. Eur J Orthod, 40:268-272, 2018. 
  11. Marcus CL : Sleep-disordered breathing in children. Am J Respir Crit Care Med, 164:16-30, 2001.  https://doi.org/10.1164/ajrccm.164.1.2008171
  12. Ahn YM : Treatment of obstructive sleep apnea in children. Korean J Pediatr, 53:872-879, 2010.  https://doi.org/10.3345/kjp.2010.53.10.872
  13. Lee HW : Role of history taking and questionnaires when approaching sleep disorders. J Korean Sleep Res Soc, 6:1-3, 2009.  https://doi.org/10.13078/jksrs.09001
  14. Spruyt K, Gozal D : Pediatric sleep questionnaires as diagnostic or epidemiological tools: a review of currently available instruments. Sleep Med Rev, 15:19-32, 2011.  https://doi.org/10.1016/j.smrv.2010.07.005
  15. Bertran K, Mesa T, Brockmann PE, et al. : Diagnostic accuracy of the Spanish version of the pediatric sleep questionnaire for screening of obstructive sleep apnea in habitually snoring children. Sleep Med, 16:631-636, 2015.  https://doi.org/10.1016/j.sleep.2014.10.024
  16. Yuksel H, Sogut A, Yilmaz O, Kutluay E : Reliability and validity of the Turkish version of the pediatric sleep questionnaire: a tool for prediction of sleep related breathing disorder. Tuberk Toraks, 59:236-241, 2011.  https://doi.org/10.5578/tt.2467
  17. Tomas Vila M, Miralles Torres A, Beseler Soto B : Spanish version of the Pediatric Sleep Questionnaire (PSQ). A useful instrument in investigation of sleep disturbances in childhood. Reliability analysis. An Pedatr (Barc), 66:121-128, 2007.  https://doi.org/10.1157/13098928
  18. Dayyat E, Kheirandish-Gozal L, Gozal D, et al. : Obstructive sleep apnea in children: relative contributions of body mass index and adenotonsillar hypertrophy. Chest, 136:137-144, 2009.  https://doi.org/10.1378/chest.08-2568
  19. Xu Z, Cheuk DK, Lee SL : Clinical evaluation in predicting childhood obstructive sleep apnea. Chest, 130:1765-1771, 2006.  https://doi.org/10.1016/s0012-3692(15)50899-4
  20. Kramer MF, De La Chaux R, Rasp G, et al. : Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome. Acta Otolaryngol, 121:494-499, 2001.  https://doi.org/10.1080/00016480118204
  21. Je Ming Hu, Chin Sheng Lin, Sy Jou Chen, et al. : Association of between obstructive sleep apnea and atopic dermatitis in children: A nationwide, population-based cohort study. Pediatr. Allergy Immunol, 29:260-266, 2018.  https://doi.org/10.1111/pai.12853
  22. Kai Jen Tien, Chien Wen Chou, Shang Yu Lee, et al. : Obstructive sleep apnea and the risk of atopic dermatitis: A population-based case control study. PLoS One, 9:e89656, 2014.