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Natural history of primary snoring in children
C L Marcus1, A Hamer, G M Loughlin
1The Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland, USA. cmarcus@welchlink.welch.jhu.edu
Insights
Most children with primary snoring (PS) do not develop obstructive sleep apnea syndrome (OSAS). A small number may progress to mild OSAS, but parental concerns about breathing difficulties are not reliable indicators.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
Background:
- Primary snoring (PS) is common in children, but its progression to obstructive sleep apnea syndrome (OSAS) is not well understood.
- Children with PS often present with symptoms suggestive of OSAS, necessitating further investigation.
Purpose of the Study:
- To determine if children diagnosed with primary snoring (PS) progress to obstructive sleep apnea syndrome (OSAS).
- To evaluate the long-term outcomes of PS in a pediatric cohort.
Main Methods:
- Repeated polysomnography was performed on 20 children previously diagnosed with PS.
- Follow-up assessments occurred 1-3 years after the initial diagnosis.
- Parental reports on snoring and breathing difficulties were collected.
Main Results:
- No significant changes in apnea index, SpO2, or PCO2 were observed for the group.
- Two children (10%) developed mild OSAS upon reevaluation.
- Parental perception of breathing difficulties did not correlate with polysomnographic findings.
Conclusions:
- Primary snoring in children rarely progresses to obstructive sleep apnea syndrome over several years.
- When progression occurs, OSAS is typically mild.
- Parental concern is an unreliable predictor of sleep-disordered breathing abnormalities in children with PS.
Abstract:
It is not known whether children with primary snoring (PS) progress to develop obstructive sleep apnea syndrome (OSAS). Therefore, we repeated polysomnography in a cohort of 20 children diagnosed 1-3 years previously with PS. All children initially presented with symptoms suggestive of OSAS. They were diagnosed with PS when initial polysomnography demonstrated snoring, with less than one obstructive apnea per hour, normal gas exchange, and infrequent arousals. Of 75 potential candidates, 20 were available for reevaluation (33 could not be contacted, 8 had undergone tonsillectomy and adenoidectomy, and 14 declined). Mean age was 6 +/- 4 (SD) years at the time of the initial study. The initial apnea index was 0.2 +/- 0.3, SpO2 nadir 95 +/- 2%, and peak end-tidal PCO2 was 47 +/- 3 mm Hg. At follow-up, all children were reported by their parents to still be snoring; in 20% snoring had reportedly increased, and in 70% there was no change. Eighty percent were thought to have difficulty breathing during sleep. For the group as a whole, there were no significant changes in apnea index, SpO2, or peak end-tidal PCO2. However, two children had mild OSAS on repeat polysomnography (apnea index of 3). We conclude that, in most children, primary snoring does not progress to OSAS over the course of several years. This study indicates that OSAS in the few individuals who do progress is mild. Parental concern about children's breathing patterns during sleep is a poor predictor of polysomnographic abnormalities. However, because many patients were lost to follow-up in this study, further prospective studies are needed.