Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study.

BACKGROUND AND OBJECTIVE: The purpose of this study is to assess whether Chinese children with high apnea-hypopnea index (AHI) are sleepier by a modified Epworth Sleepiness Scale (ESS). MATERIALS AND METHODS: Records were retrospectively reviewed. We included children who were between 3 and 12 years old, admitted for overnight polysomnogram because of suspected obstructive sleep apnea syndrome (OSAS). A modified ESS was used to assess excessive daytime sleepiness (EDS) of the children. RESULTS: One hundred ninety-two Chinese children were included. Children with high AHI, defined as AHI > 5.0, were sleepier than children with AHI less than or equal to 5. After adjustment by age, gender, and obesity, children with high AHI remained significantly sleepier. Modified ESS was significantly correlated with AHI (rho = 0.124, 95% CI = 0.004-0.281). Modified ESS score of >8 was the best cutoff point with the sensitivity and specificity of 0.29 and 0.91, respectively. The odds ratio of children with modified ESS > 10 having high AHI was 4.231 (95%CI = 1.248 to 14.338) and children with modified ESS > 8 had the highest odds ratio, 4.295(95%CI = 1.66 to 11.1), of having high AHI. CONCLUSION: Chinese children with high AHI appear to be sleepier than children with low AHI. Children with suspected OSAS and high modified ESS, i.e., ESS > 8, had significantly higher odds ratio of having high AHI. Increased sleepiness is a specific but not a sensitive symptom in snoring children with high AHI. Screening for EDS in snoring children may help us identify those with high AHI and prioritize the management of those children.

Application of videotape in the screening of obstructive sleep apnea in children.

OBJECTIVE: To determine if watching a videotape that shows features of obstructive sleep apnea (OSA) will improve the accuracy of a verbally administered questionnaire in the prediction of OSA in pediatric snorers. PATIENTS AND METHODS: In a prospective single-blinded, randomized, controlled study at a pediatric clinic for sleep-disordered breathing, we studied children aged 0-18 years, who had been referred to a sleep laboratory for overnight polysomnography (PSG), and their parents from November 1999 to November 2000. The parents were randomized to answer a standard verbally administered panel of three questions (SQ) or a verbally administered panel of questions assisted by videotape (VQ). RESULTS: The parents of 52 and 56 pediatric snorers were assigned to answer SQ and VQ, respectively. The areas under the receiver operating characteristic [ROC] curves (AUCs) for screening of OSA in patients were similar at 0.709 (95% confidence interval (CI)=0.561-0.851) for SQ and 0.714 (95% CI=0.571-0.858) for VQ. The two questionnaires had a reasonable negative predictive value to rule out the presence of OSA (VQ=0.816 and 95% CI=0.726-0.885, SQ=0.828, 95% CI=0.714-0.913). CONCLUSION: The addition of a videotape showing important features of OSA achieved no better accuracy than a standard questionnaire.

The correlation among obesity, apnea-hypopnea index, and tonsil size in children.

BACKGROUND: The correlation between obesity and severity of obstructive sleep apnea (OSA) is well established in adults, but data are inconsistent in children. We hypothesized that there is a significant correlation between the degree of obesity and the severity of OSA in children. METHODS: We retrospectively reviewed records of weight, height, history, and polysomnography of all 1- to 15- year-old children referred to our sleep laboratory. Children with known anomalies and repeated polysomnography were excluded from this study. Obesity was defined as body mass index z score (BMI Z score) > 1.96. The correlation between BMI Z score and apnea-hypopnea index (AHI) was assessed. Possible confounding factors, ie, age, gender, and tonsil size, were adjusted by multiple linear regression. RESULTS: Four hundred eighty-two children were included in this study. Obese children had a significantly higher AHI (median, 1.5; interquartile range [IQR], 0.2 to 7.0) than the AHI of nonobese children (median, 0.7; IQR, 0.0 to 2.5). BMI Z score was significantly correlated with log-transformed AHI (Ln[AHI]) [r = 0.156, p = 0.003]. BMI Z score and tonsil size were still correlated with Ln(AHI) even after adjusted for other confounding factors (p = 0.001). CONCLUSION: Degree of obesity as measured by BMI Z score and tonsil size are significantly related to severity of OSA as reflected by the AHI, although the correlation is mild.

Twenty-four-hour ambulatory BP in snoring children with obstructive sleep apnea syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a known risk factor for hypertension in adults. This relationship is less clear in childhood OSAS. OBJECTIVE: This study examined the relationship between OSAS and 24-h ambulatory BP (ABP), a more accurate assessment than casual BP, in children with snoring. METHODS: Snoring children aged 6 to 15 years who underwent polysomnography in the sleep laboratory were recruited. MEASUREMENT: Twenty-four-hour ABP monitoring was initiated a few hours before polysomnography. The children were classified into two groups: a high apnea-hypopnea index (AHI) group (obstructive AHI > 5/h), and a low-AHI group (AHI < or = 5/h). Mean sleep, wake, and 24-h systolic BP (SBP) and diastolic BP (DBP) were recorded. A child was considered a "nondipper" if his or her mean SBP and DBP did not decrease by >/= 10% during sleep. RESULTS: Ninety-six children (mean age +/- SD, 9.4 +/- 2.8 years) were recruited. Forty-one children were obese. When awake, the high-AHI group children had a significantly higher SBP. When asleep, both SBP and DBP were higher in the high-AHI group. Age, body mass index (BMI) z score, and desaturation index (DI) were significant predictors for elevated sleep DBP. BMI z score was the only significant predictor for wake and sleep SBP. Sixteen children (17%) had hypertension, and all were nondippers. Obese children in the high-AHI group had a significantly higher prevalence of hypertension than obese children in the low-AHI group. This relationship was not found in nonobese children. CONCLUSION: The current study shows that increased DI contributed to the elevation of sleep DBP elevation.

An update on childhood snoring.

UNLABELLED: Habitual snoring or daily snoring is a symptom of sleep-disordered breathing (SDB) in children and it is reported in about 10% of children. SDB includes primary snoring, upper airway resistance syndrome (UARS), obstructive hypoventilation syndrome and obstructive sleep apnea syndrome (OSAS). Classification of SDB in a particular snoring child requires an overnight polysomnography (PSG). Manual scoring of PSG is mandatory in children. Risk factors for SDB include allergic rhinitis, passive smoking, obesity, dysmorphic syndromes and neuromuscular disorders. CONCLUSION: Treatment includes general measures like treatment of allergic rhinitis, weight reduction in obese children, and avoidance of sleep deprivation. Specific measures include removal of adenoid and tonsils. Complications of SDB include neurocognitive impairment, hypertension and failure to thrive.

Prevalence of sleep problems in Hong Kong primary school children: a community-based telephone survey.

STUDY OBJECTIVES: To estimate the prevalence of snoring, witnessed sleep apnea, teeth grinding, primary and secondary nocturnal enuresis, and sleep duration in Hong Kong primary school children. DESIGN: Cross-sectional telephone questionnaire survey in a community. PARTICIPANTS: A total of 3,047 6- to 12-year-old apparently healthy children. INTERVENTION: Those who agreed to the study were contacted by telephone. Survey questions were asked about the symptoms of the different sleep disorders, and the frequency of each positive symptom was noted for the preceding 1 week. OUTCOME MEASURES: Prevalence and risk factors of sleep disorders in Hong Kong primary school children. RESULTS: The prevalence of the following sleep symptoms was listed as follows: habitual snoring (10.9%), witnessed sleep apnea (1.5%), nocturnal enuresis (5.1%), and sleep teeth grinding (20.5%). Significant risk factors for habitual snoring included witnessed sleep apnea, mouth breathing during sleep, snoring in first-degree relatives, headache on rising, male gender, allergic rhinitis, and sleep teeth grinding. Significant risk factors for witnessed sleep apnea included habitual snoring, allergic rhinitis, tiredness on rising, and excessive daytime sleepiness. Poor academic results were associated with present of witnessed sleep apnea and absence of sleep teeth grinding. None of the sleep problem was associated with poor conduct results. The mean sleep duration was 8.79 h (SD 0.96). CONCLUSIONS: This study provides epidemiologic data of sleep-disordered breathing, enuresis, sleep teeth grinding, and duration of sleep in Chinese primary school children in Hong Kong.