Six-month follow-up of children with obstructive sleep apnoea.

OBJECTIVES: This study examined prospectively changes in development, temperament and sleep related behaviour in children referred for obstructive sleep apnoea (OSA) and polysomnographic sleep study, some of whom had surgical intervention. METHODOLOGY: Using a prospective cohort study design, parents of 56 children referred for OSA completed sleep and temperament questionnaires and their child was assessed developmentally at the time of the polysomnographic sleep study. Forty (72%) of the children were neurologically normal. At 6 months, 42 children were reassessed using sleep and temperament questionnaires and a developmental assessment. After excluding the primary snorers, subjects were categorised as having had intervention (n = 24) or not (n = 15), and differences over the 6-month period in Griffiths scores, temperament and sleep related behaviour were examined. RESULTS: Regardless of intervention status, there was an improvement in night-time and day-time sleep behaviour for the total group, though the extent of improvement was more marked in the intervention group. For the neurologically normal children, improvement in the sleep behaviour was only significant for the intervention group (P < 0.05). Intervention did not result in any significant changes in Griffiths developmental score or temperament. CONCLUSION: Surgical intervention improves sleep behaviour in children though not temperament or development.

Aetiological factors and development in subjects with obstructive sleep apnoea.

OBJECTIVE: To examine whether maternal pregnancy complications, adverse birth events, respiratory illnesses, or developmental difficulty were increased in neurologically normal children with obstructive sleep apnoea (OSA) and whether severity of OSA adversely affects the child's development and temperament. METHODOLOGY: Maternal report of perinatal events, respiratory illness and developmental difficulty in 37 children with OSA was contrasted with a comparison group (n = 67). Children with OSA were assessed developmentally (Griffiths Scales), had a parental rating of temperament (Australian Temperament Scale) and attended an overnight polysomnographic sleep study. RESULTS: Children with OSA had an increased prevalence of adverse maternal pregnancy and perinatal events, respiratory disease and developmental concerns. Limited associations were found between the severity of OSA and development or temperament difficulty. CONCLUSIONS: This study suggests a relationship between OSA, though not its severity, and pre/perinatal adversity and child development. Polysomnographic and detailed developmental assessment of community-based samples of children with OSA and control children are necessary to confirm these findings.

Clinical versus polysomnographic profiles in children with obstructive sleep apnoea.

OBJECTIVE: To examine the clinical and polysomnographic (PSG) profiles of neurologically normal and abnormal children with obstructive sleep apnoea (OSA) and explore the relationship between these profiles. METHODOLOGY: We enrolled 56 children with persistent snoring and OSA for the study, 16 of whom were neurologically abnormal. All children were examined clinically and attended an overnight PSG study. Total clinical scores, PSG scores, and mild/moderate or severe ratings were derived for each child. RESULTS: Comparison of individual PSG parameters with neurological status demonstrated that the abnormal children had significantly increased obstructive apnoea indices, increased desaturation events and lower mean arousal indices compared to their neurologically normal OSA peers. For the neurologically abnormal children, there was a significant correlation between severity ratings of disease according to clinical and PSG profiles (r = 0.56, P = 0.03, sensitivity 82%) using the clinical summary as the gold standard, although the association was less marked in the neurologically normal children (r = -0.08, P = NS, sensitivity 69%). CONCLUSION: Neurologically abnormal children are likely to have more severe abnormalities in selected polysomnographic indices and overall scores. However, the clinical assessment is only likely to reflect this at the severe end of the spectrum. These relationships are not seen in the neurologically normal child, where little or no reliance can be placed upon predicting the severity of the polysomnographic findings from the clinical data. Decisions regarding the severity of disease and treatment should be based on the combined findings of the clinical and PSG data rather than overall clinical and polysomnographic scores or selected clinical and polysomnographic parameters.