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http://dx.doi.org/10.3345/kjp.2008.51.3.267

Discrimination between obstructive sleep apnea syndrome and primary snoring in children : comparison of clinical parameters and behavioral disturbance  

Seo, Hyun-Joo (Department of Pediatrics, Eulji University School of Medicine)
Lee, Jae Suk (Department of Pediatrics, Eulji University School of Medicine)
Shin, Hong-Beom (Department of Psychiatry, Eulji University School of Medicine)
Kim, Eui-Joong (Department of Psychiatry, Eulji University School of Medicine)
Shim, Hyun-Joon (Department of Otolaryngology, Eulji University School of Medicine)
Ahn, Young-Min (Department of Pediatrics, Eulji University School of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.51, no.3, 2008 , pp. 267-275 More about this Journal
Abstract
Purpose : To determine whether primary snoring could be distinguished from obstructive sleep apnea syndrome (OSAS) by clinical evaluation and symptom scores. Methods : 56 snoring and 20 asymptomatic subjects were recruited and polysomnography was used to confirm that there were 39 OSAS, 17 primary snoring, and 20 control subjects. We evaluated the size of the childrens adenoids and tonsils. Parents completed sleep disordered breathing scale (SDBS) and obstructive sleep apnea 18 (OSA-18) questionnaires for use as symptom scores, as well as an attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV). Results : There were no differences between primary snoring and OSAS in terms of tonsil and adenoid size, SDBS ($9.4{\pm}4.6\;vs\;10.8{\pm}4.5$), and OSA-18 score ($61.1{\pm}25.1\;vs\;71.2{\pm}8.4$). The patients with OSAS ($15.8{\pm}7.9$) and PS ($22.2{\pm}9.4$) had a higher ADHD RS-IV score than the control subjects ($2.9{\pm}3.3$). There was no difference in the ADHD RS-IV scores of patients with primary snoring and OSAS. Conclusion : We confirmed that clinical evaluation could not distinguish OSAS and primary snoring. In addition, our study suggests that primary snoring as well as OSAS is associated with attention deficit hyperactivity disorder.
Keywords
Obstructive sleep apnea syndrome; Primary snoring; Attention deficit hyperactivity disorder; Polysomnography;
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Times Cited By KSCI : 1  (Citation Analysis)
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1 American Thoracic Society. Cardiorespiratory sleep studies in children. Establishment of normative data and polysom-nographic predictors of morbidity. Am J Respir Crit Care Med 1999;160:1381-7   DOI   ScienceOn
2 Gozal D, O'Brien LM. Snoring and obstructive sleep apnoea in children: why should we treat? Paediatr Respir Rev 2004; 5(Suppl A):S371-6   DOI   ScienceOn
3 Cheshire K, Engleman H, Deary I, Shapiro C, Douglas NJ. Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Arch Intern Med 1992;152:538-41   DOI
4 Carroll JL, Loughlin GM. Obstructive sleep apnea syndrome in infants and children : clinical features and pathophysiology. In : Ferber R, Kryger M. Principles and practice of sleep medicine in the child. Philadeiphia: WB Saunders Co, 1995:163-91
5 Schechter MS. The Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Technical report: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:e69   DOI
6 Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989;36:1551-69   DOI
7 Franco RA Jr, Rosenfeld RM, Rao M. First place-resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 2000; 123:9-16   DOI   ScienceOn
8 DuPaul GJ. Parent and teacher rating of ADHD symptoms: psychometric properties in a community based sample. J Clin Child Psychol 1991;20:245-53   DOI   ScienceOn
9 Kim YS, So YK, Noh JS, Choi NK, Kim SJ. Normative data on the Korean ADHD rating scales (K-ARS) for parents and teacher. J Korean Neuropsychiatr Assoc 2003;42:352-9
10 Klem GH, Luders HO, Jasper HH, Elger C. The ten-twenty electrode system of the international federation. The International Federation of clinical neurophysiology. Electroencephalogr Clin Neurophysiol Suppl 1999;52:3-6
11 Daniel K, Chow PY, Chan CH, Kwok KL, Cheung JM, Kong FY. An update on childhood snoring. Acta Pediatr 2006;95:1029-35   DOI
12 Kohyama J. Ohinata JS, Hasegawa T. Blood pressure in sleep disordered breathing. Arch Dis Child 2003;88:139-42   DOI
13 Lim HW, Lee SH. Correlation between quality of life and indices of polysomnography in children with ostructive sleep apnea syndrome. Korean J Otolaryngol 2006:49:35-40
14 Rosen CL, Kass LJ, Haddad GG. Obstructive sleep apnea and hypoventilation in children. In : Behrman RE, Kliegman RM, Jenson HB. Nelson textbook of pediatrics. 17th ed. Philadelphia: PA Saunders Co, 2004:1397-401
15 Exar EN, Collop NA. The upper airway resistance syndrome. Chest 1999;115:1127-39   DOI   ScienceOn
16 Chervin RD, Ruzika DL, Hedger K, Dillon JE. Snoring predicts hyperactivity four years later. Sleep 2005;27:885-90
17 Brodsky L, Moore L, Stanievich JE, A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 1987;13:149-56   DOI   ScienceOn
18 Fujioka M, Young LW, Girdany BR. Radiolographic evaluation of adenoidal size in children; Adenoidal-nasopharyngeal ratio. Am J Roentgenal 1979;133:401-4   DOI   ScienceOn
19 Arman AR, Ersu R, Save D, Karadag B, Karaman G, Karabekiroglu K, et al. Symptoms of inattention and hyperactivity in children with habitual snoring: evidence from a community-based study in Istanbul. Child Health Dev 2005; 31:707-17   DOI   ScienceOn
20 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 2000;1:21-32   DOI   ScienceOn
21 Wang RC, Elkins TP, Keech D, Wauquier A, Hubbard D. Accuracy of clinical evaluation in pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 1998;118:69-73   DOI   ScienceOn
22 Marcus CL, Carroll JL. Obstructive sleep apnea syndrome. In : Loughlin GM, Eigen H. Respiratory disease in children: diagnosis and management. Baltimore: Williams & Wikins Co, 1994:475-99
23 Suen JS, Arnold ]E, Brooks LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525-30   DOI   ScienceOn
24 Chervin RD, Hedger K, Dillon JE, Panahi P, Pituch KJ, Dahl RF, et al. Inattention, hyperactivity, and symptom of sleep-disordered breathing. Pediatrics 2002;109:449-56   DOI   ScienceOn
25 Gislason T, Benediktsdottir B. Snoring, apneic episodes, and noctunal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest 1995;107:963-6   DOI   ScienceOn
26 Kwok KL, Ng DK, Cheung YF. BP and arterial distensibility in children with primary snoring. Chest 1998;157:1098-103
27 Leach J. Olson J. Hermann J. Manning S. Polysomnographic and clinical findings in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992;118:741-4   DOI   ScienceOn
28 Rechtschaffen A, Kales A. Manual of standard terminology, technique and scoring system for sleep stages of human subjects. Los Angeles: Brain Information Service/Brain Research Institute UCLA, 1968
29 Carroll JL, McColley SA, Marcus CL, Curtis S, Loughlin GM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest 1995;108:610-8   DOI   ScienceOn
30 Goldstein NA, Sculerati N, Walsleben JA, Bhatia N, Friedman DM, Rapoport DM. Clinical diagnosis of pediatric obstructive sleep apnea validated by polysomnography. Otolaryngol Head Neck Surg 1994;111:611-7   DOI   ScienceOn
31 Melendres MC, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics 2004;114:768-75   DOI   ScienceOn
32 Nieminen P, Tolonen U, Lopponen H. Snoring and obstructive sleep apnea in children: a 6-month follow-up study. Arch Otolaryngol Head Neck Surg 2000;126:481-6   DOI
33 Goldstein NA, Pugazhendhi V, Rao SM, Weedon J, Campbell TF, Goldman AC. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics 2004;114:33-43   DOI   ScienceOn
34 Conatantin E, Kermack A, Nixon GM, Tidmarsh L, Ducharme FM, Brouillette RT. Adenotonsillectomy improves sleep, breathing, and quality of life but not behavior. J Pediatr 2007;150:540-6   DOI   ScienceOn
35 Schechter MS. The Section on Pediatric Pulmonology, Subcomittee on Obstructive Sleep Apnea Syndrome. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704-12   DOI   ScienceOn
36 DuPaul GJ, Power TJ, Anastopoulos AD, Reid R, McGoey KE, Ikeda MJ. Teacher ratings of attention-deficit/hyperactivity disorder: Factor structure and normative data. Psychological Assessment 1997;9:436-44   DOI   ScienceOn
37 Gottlieb DJ, Chase C, Vezina RM, Heeren TC, Corwin MJ, Auerbach SH, et al. Sleep disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children. J Pediatr 2004;145:458-64   DOI   ScienceOn
38 Valera FC, Avelino MA, Perttermann MB, Fuljita R, Pig na tari SS, Moreira GA, et al. OSAS in children: Correlation between endoscopic and polysomnographic findings. Otolaryngol Head Neck Surg 2005;132:268-72   DOI   ScienceOn
39 Guilleminault C, Winkle R, Korobkin R, Simmons B. Children and nocturnal snoring: Evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr 1982;139:165-71   DOI
40 Tal A, Leiberman A, Margulis G, Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol 1998;4:139-42   DOI   ScienceOn