SNORING CHILDREN - FACTORS PREDICTING SLEEP-APNEA

Many snoring children present obstructive symptoms according to their parents. The seriousness of the symptoms and the possibility of the ob structive sleep apnea syndrome (OSAS) in these children may be difficu lt to judge on the basis of the clinical findings and the patient's hi story only. In order to evaluate snoring children's relative risk (RR) to have OSAS, their symptoms and signs, as reported by the parents, a nd clinical findings were compared with the results of overnight polys omnography (PSG). An obstructive apnea index (AI) greater than or equa l to 1 in PSG was regarded as the criterion for OSAS. The mean AI was 1.55 (range 0-15), and 29 children had a pathological AI, while 49 had a normal PSG recording. Apneic episodes every night detected by the p arents was the most important single risk factor for OSAS (RR 3.6, 95% confidence interval (CI) 1.7-7.7). The RR ratio decreased when apneas appeared less frequently, but any detected apnea was still a single r isk factor (RR 1.4, CI 1.2-1.8). The other risk factors of night-time symptoms were constant snoring (RR 1.5, CI 1.0-2.1) and restless sleep (RR 2.1, CI 1.1-4.0). Of the daytime symptoms, absence of excessive s leepiness was a protective factor against OSAS (RR 0.3, CI 0.1-1.0). P revious adenoidectomy was found to be a risk factor (RR 1.7, CI 1.1-2. 7), as was tonsillar enlargement (RR 1.4, CI 1.1-1.8). These two findi ngs suggest that the epipharyngeal space does not play a central role in the development of OSAS in children. OSAS cannot be reliably diagno sed without PSG, which is the most important examination for snoring c hildren with obstructive symptoms. For clinical decisions, the conside ration of risk factors is essential.