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The development of snoring and sleep related breathing distress from 4 to 6 years in a cohort of Swedish children
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2007 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, Vol. 71, no 7, 1025-1033 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Snoring is common among both children and adults and a sign of sleep disordered breathing (SDB). Adenotonsillectomy is often the solution offered, although the effect is uncertain. There are also some who say that young children who snore will outgrow it even without treatment. The present investigation compares snoring and co-founding symptoms in parental reports for a cohort of children at age 4 and at age 6 years. METHOD: A cohort of 4 year old chidren (615) was investigated with respect to SDB [B. Löfstrand-Tideström, B. Thilander, J. Ahlqvist-Rastad, O. Jakobsson, E. Hultcrantz, Breathing obstruction in relation to craniofacial and dental arch morphology in 4 year old children, Eur. J. Orthod. 21 (1999) 323-332]. Each child was given a questionnaire. Those reporting significant symptoms also received a clinical and an orthodontic examination. Forty-eight children were diagnosed with SDB; of these 28 were operated with adenoidectomy and/or tonsillectomy. After 2 years, the same questionnaire was administered and the same children as before were further examined as well as those newly reporting significant symptoms. The results from the two occasions were compared. RESULTS: Eighty-three percent (509) of the original cohort participated. The frequency of snoring had changed from 53 to 46% for the group as a whole (p<0.05). Significant gender differences in co-founding symptoms were seen. Severity of snoring had changed on an individual basis in half of the cases; some recovered, others got worse. Of the children with SDB at 4 years who were operated, 14/28, did not snore at all, compared to 3/18 of the non-operated (p<0.05). CONCLUSION: Children who snore at the age 4 seldom "grow out of it" by age 6 and still show other signs of sleep related distress as well. Surgery does not always cure the snoring, thus postoperative follow-up is important. Since new cases develop during this age period, early intervention is not enough.

Place, publisher, year, edition, pages
2007. Vol. 71, no 7, 1025-1033 p.
Keyword [en]
snoring, children, epidemiology
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-107990DOI: 10.1016/j.ijporl.2007.03.005PubMedID: 17482278OAI: oai:DiVA.org:uu-107990DiVA: diva2:233853
Available from: 2009-09-02 Created: 2009-09-02 Last updated: 2010-03-23Bibliographically approved
In thesis
1. Sleep Disordered Breathing and Orofacial Morphology in Relation to Adenotonsillar Surgery: Development from 4-12 Years in a Community Based Cohort
Open this publication in new window or tab >>Sleep Disordered Breathing and Orofacial Morphology in Relation to Adenotonsillar Surgery: Development from 4-12 Years in a Community Based Cohort
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: To follow a cohort of children from age 4-6-12 with respect to sleep disordered breathing (SDB) and orofacial development. Questionnaires were completed about sleep, snoring, apneas, enuresis, sucking habits, and adenotonsillar surgery and, from age 12, about allergies, asthma, and general health. Children snoring regularly had an ENT- examinations including sleep studies (at ages 4 and 12) and an orthodontic evaluation. Development of biometric data in snoring children and not snoring controls was studied in relation to adenotonsillar surgery.

Result: Of the original group of 615 children, 509 (83%) participated at age 6 and 393 (64%) at age 12. 27 snored regularly and 231 did not snore at age 12. Differences between groups were seen on all answers. From age 4–12 the prevalence of OSA decreased from 3.1% to 0.8%, and the minimum prevalence of snoring regularly from 5.3% to 4.2%. The odds for a child who snored regularly at four or six to be snoring regularly at age 12 was 3.7 times greater than for a not snoring child in spite of surgery (OR 3.7, 95% CI 2.4-5.7). 63 children were operated for snoring by age 12, of them 14 never snored and 17 snored regularly at age 12. Cross-bite was more common among snoring children at ages 4, 6 and 12 as was a narrower maxilla. In most cases, surgery cured the snoring temporarily, but the maxillar width was still smaller by age 12—even when nasal breathing was attained.

Children snoring regularly at age 12, operated or not operated, showed long face anatomy and were oral breathers; the seven cases who were not operated and the five who were still snoring in spite of surgery, did not have reduced maxillary arch width.

Conclusion: The prevalence of children snoring regularly is about the same from age four to twelve in a cohort where adenotonsillar surgery has been performed on obstructed cases, but the prevalence of OSA decreases considerably. The children snoring regularly have a more narrow maxilla compared to children not snoring—a condition that is not changed by adenotonsillar surgery regardless of symptom relief.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 57 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 480
snoring, children, epiddemiology, adenotonsilloectomy, craniofacial development
National Category
Research subject
urn:nbn:se:uu:diva-108031 (URN)978-91-554-7600-7 (ISBN)
Public defence
2009-10-10, Skoogsalen, Akademiska Sjukhuset ingång 79, Uppsala, 09:15 (Swedish)
Available from: 2009-09-18 Created: 2009-09-03 Last updated: 2009-10-08Bibliographically approved

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