Published online August 31, 2005
PEDIATRICS
Vol. 116
No. 3
September 2005, pp.
797-798
(doi:10.1542/peds.2005-1166)
Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing
Rafael Pelayo, MD
Department of Psychiatry and Behavioral Science
Stanford Sleep Disorders Clinic
Stanford, CA 94305
Yakov Sivan, MD
Division of Pediatric Pulmonology
Sackler Faculty of Medicine
Tel Aviv University
Tel Aviv 69978, Israel
To the Editor.—
Perhaps one of the greatest challenges facing pediatric sleep medicine is the paucity of large epidemiologic studies. Given this paucity, we read with interest the article "Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing" by Rosen and colleagues.1 This study used a nonclinical, unreferred, community-based cohort, which undoubtedly will generate a wealth of data. One of the results reported that was not discussed in the text caught our attention and merits additional consideration. The authors reported that only 55% of the parents of children diagnosed with a polysomnogram with obstructive sleep apnea (OSA) reported snoring. Based on these results, nearly half of the children with OSA did not have a parental history of snoring. This rate is considerably lower than expected. Parents may not be aware of how their children sleep, but 45% is an impressive number. If pediatricians and surgeons screen for OSA by asking the parents/caregiver if the child snores, they may miss close to half of the cases.
In this study, a history of snoring was considered positive when the caregivers answered "yes" to the statement "loud snoring in the past month" at least 1 to 2 times per week. We wonder whether this low rate is a result of, at least in part, limiting parents' response to "loud snoring." In that case, a significantly higher rate of positive answers would have been obtained if "snoring" (any snoring) was included, which could have significantly influenced the results of the study; the authors defined sleep-disordered breathing (SDB) by a positive answer to that statement and defined primary snoring as a positive answer that was accompanied by an apnea hypopnea index of <5. The authors used SDB for correlation with behavioral morbidity.
It would be interesting to know how many children with OSA not reported to snore actually snored on the polysomnogram. The degree of bed sharing between the child and parents/caregiver may also be important; it may suggest the need to lower the threshold for clinical suspicion of OSA when snoring is used to screen children for additional evaluation. If, on the contrary, many children with OSA do not snore, then this result should also be emphasized, because it affects our clinical screening of children at risk for OSA. This situation would support the need to further study snoring in children with SDB.
REFERENCE
- Rosen CL, Storfer-Isser A, Taylor HG, Kirchner HL, Emancipator JL, Redline S. Increased behavioral morbidity in school-aged children with sleep-disordered breathing.
Pediatrics. 2004;114
:1640
–1648[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
