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Zhu Q, Wada H, Ueda Y, Onuki K, Miyakawa M, Sato S, Kameda Y, Matsumoto F, Inoshita A, Nakano H, Tanigawa T. Association between habitual snoring and vigilant attention in elementary school children. Sleep Med 2024; 118:9-15. [PMID: 38579378 DOI: 10.1016/j.sleep.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES Vigilant attention (VA) is a fundamental neurocognitive function. However, the association between habitual snoring (HS) and VA in community-based children remains unclear. Therefore, this study aimed to elucidate the association. METHODS The study included 2014 children from grades 1-6 across six elementary schools. Snoring frequency was evaluated using a questionnaire administered to parents. VA was assessed using a brief 3-min psychomotor vigilance test (PVT-B). Generalized linear models and multivariate logistic regression analysis were utilized to examine the association between snoring frequency and PVT-B performance. Impaired PVT-B performance was defined as the worst quartile of PVT-B metrics. RESULTS The PVT-B performance significantly improved with advancing school grade level (p trend < 0.0001). A significant negative correlation was observed between snoring frequency and PVT-B performance. Particularly, in grade 1, HS was associated with a higher risk of impaired PVT-B performance, including response speed (mean reciprocal reaction time) (adjusted odds ratio [aOR] 2.56, 95% confidence interval [CI]: 1.20-5.50), more slowest 10% RT (aOR 3.28, 95% CI: 1.51-6.88), and more lapse500 (number of lapse of reaction time ≥ 500 ms) (aOR 3.18, 95% CI: 1.45-6.80) compared to children without snoring. CONCLUSIONS Our findings show that VA rapidly improves throughout elementary school. Additionally, younger children with HS are at risk of VA deficits, emphasizing the importance of early intervention for HS.
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Affiliation(s)
- Qinye Zhu
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Yuito Ueda
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Keisuke Onuki
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Mariko Miyakawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Setsuko Sato
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Yosihito Kameda
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Ayako Inoshita
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Hiroshi Nakano
- Sleep Disorders Centre, National Hospital Organization Fukuoka National Hospital, Yakatabaru, Minami-Ku, Fukuoka City, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan.
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Magnusdottir S, Hill EA. Prevalence of obstructive sleep apnea (OSA) among preschool aged children in the general population: A systematic review. Sleep Med Rev 2024; 73:101871. [PMID: 37976758 DOI: 10.1016/j.smrv.2023.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Untreated pediatric obstructive sleep apnea (OSA) is associated with significant morbidities affecting behavior, neurocognitive development, endocrine and metabolic health. This systematic review evaluated prevalence of OSA reported in population-based studies among preschoolers as early intervention may have positive effects on health and quality of life. Thirty studies were included. High degrees of heterogeneity in methods and definitions were observed between the studies. Seven studies confirmed OSA by implementing objective methods after screening for habitual snoring with only two studies utilizing polysomnography, the reference standard, testing 1.2% of the combined cohorts (n = 82/4575) to confirm disease. Diagnosis of OSA was based on utilizing retired thresholds of the apnea-hypopnea-index (AHI), AHI4%≥5/hour of sleep (hrSleep), reporting prevalence of 1.8% and 6.4%, respectively. The remaining five studies implemented relatively insensitive objective recording methods to confirm disease in a limited number of children (n = 449/2486; 18.0%), estimating prevalence in the range of 0.7%-13.0%. The remaining literature is based on implementing questionnaires only to evaluate OSA. Studies published before 2014 reported 3.3%-9.4% prevalence, while more recent studies published 2016-2023 report higher prevalence, 12.8%-20.4%, when excluding outliers. This trend suggests that prevalence of OSA may possibly have been increasing in preschoolers over the past decade.
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Affiliation(s)
- Solveig Magnusdottir
- MyCardio LLC, SleepImage®, 3200 E Cherry Creek South Drive, Denver, CO, 80209, USA.
| | - Elizabeth A Hill
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Dorothy Crowfoot Hodgkin Building, South Parks Road, Oxford, OX1 3QU, UK
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Mir Fakhraei R, Lindberg E, Benediktsdóttir B, Svanes C, Johannessen A, Holm M, Modig L, Franklin KA, Malinovschi A, Gislason T, Jõgi R, Cramer C, Janson C, Emilsson ÖI. Gastroesophageal reflux and snoring are related to asthma and respiratory symptoms: Results from a Nordic longitudinal population survey. Respir Med 2024; 221:107495. [PMID: 38101459 DOI: 10.1016/j.rmed.2023.107495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
AIM To study if individuals with nocturnal gastroesophageal reflux (nGER) and habitual snoring are more likely to develop asthma and respiratory symptoms (i.e. wheeze, cough, chest tightness, breathlessness) than those without these conditions, and if these associations are additive. METHODS We used data from the population-based prospective questionnaire study Respiratory Health in Northern Europe (RHINE) (11,024 participants), with data from 1999 and 2011. Participants with heartburn or belching after going to bed, at least 1 night/week, were considered to have nGER. Participants reporting loud snoring at least 3 nights/week were considered to have habitual snoring. Participants were grouped into four groups by their nGER and snoring status: "never"; "former"; "incident"; "persistent". Incident respiratory symptoms were analyzed among participants without respective symptom at baseline. RESULTS Snoring and nGER were independently associated with incident asthma and respiratory symptoms. The risk of incident wheeze was increased in subjects with incident or persistent snoring (adjusted odds ratio (95 % CI): 1.44 (1.21-1.72)), nGER (2.18 (1.60-2.98)) and in those with both snoring and nGER (2.59 (1.83-3.65)). The risk of developing asthma was increased in subjects with incident or persistent snoring (1.44 (1.15-1.82)), nGER (1.99 (1.35-2.93)) and in those with both snoring and nGER (1.72 (1.06-2.77)). No significant interaction was found between snoring and nGER. A similar pattern was found for the incidence of all other respiratory symptoms studied, with the highest risk among those with both incident or persistent nGER and snoring. CONCLUSION The risk of developing asthma and respiratory symptoms is increased among subjects with nGER and habitual snoring. These associations are independent of each other and confounding factors. Snoring and nGER together are additive on respiratory symptoms.
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Affiliation(s)
- Rima Mir Fakhraei
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, University of Gothenburg, Sweden
| | - Lars Modig
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali, University Hospital, Reykjavik, Iceland
| | - Rain Jõgi
- The Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Christine Cramer
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Össur Ingi Emilsson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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Lei L, Wang Y, Zhao F, Jiang Z, Zhao Y, Yu L, Zhu P, Zou J. Behavioral and cognitive outcomes of habitual snoring in children aged 2-14 years in Chengdu, Sichuan. Am J Otolaryngol 2023; 44:103691. [PMID: 36669275 DOI: 10.1016/j.amjoto.2022.103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/18/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Habitual snoring is associated with cognitive, behavioral, and other physiological problems of children. Few studies have reported specifically on the relationships between snoring and those problems in children as noticed by their parents. We aimed to identify the cognitive, behavioral, and sleep-related nocturnal problems in children with HS as noted by their parents. MATERIALS AND METHODS A cross-sectional survey was performed in Chengdu, Sichuan, China. Children aged 2-14 years from four districts were randomly chosen to participate. Questionnaires were completed voluntarily by the children's parents/guardians. RESULTS A total of 1548 questionnaires were analyzed and classified those children as 463 habitual snorers (HS group, 30.4 %), 683 occasional snorers (OS group, 44.8 %), and 402 non-snorers (NS group, 26.4 %). The percentages of children with sleep-related nocturnal symptoms were 94.6 %, 87.3 %, and 66.9 % in the HS, OS, and NS groups. Percentages of children with cognitive problems were 76.2 %, 74.6 %, and 64.9 % in the HS, OS, and NS groups, respectively (P < 0.001). The frequencies of daytime behavioral problems were 68.3 %, 61.5 %, and 46.8%in the HS, OS, and NS groups, respectively (P < 0.001).The average number of sleep-related nocturnal symptoms, cognitive symptoms and daytime behavioral problems was higher in the HS group than in the OS and NS groups. CONCLUSIONS HS is a significant contributor to sleep-related nocturnal symptoms and daytime cognitive and behavioral problems in children, as reported by their parents/guardians. HS and OS are important contributors to poor sleep quality and daytime cognitive and behavioral problems in children.
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Affiliation(s)
- Lei Lei
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Yifei Wang
- West China Medical School, Sichuan University, Sichuan, China
| | - Fanyu Zhao
- West China Medical School, Sichuan University, Sichuan, China
| | - Zijing Jiang
- West China Medical School, Sichuan University, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Lingyu Yu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Ping Zhu
- Department of Clinical Research Management, West China Hospital, Sichuan University, Sichuan, China.
| | - Jian Zou
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China.
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Gunnlaugsson S, Abul MH, Wright L, Petty CR, Permaul P, Gold DR, Gaffin JM, Phipatanakul W. Associations of Snoring and Asthma Morbidity in the School Inner-City Asthma Study. J Allergy Clin Immunol Pract 2021; 9:3679-3685.e1. [PMID: 34102347 PMCID: PMC8511301 DOI: 10.1016/j.jaip.2021.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inner-city children are disproportionately affected by asthma and sleep-disordered breathing (SDB). However, little is known about the association of SDB symptoms with asthma morbidity in this vulnerable population. OBJECTIVE Assess the relationship between snoring frequency and asthma morbidity. METHODS This study was part of the School Inner-City Asthma Study, a longitudinal prospective cohort study of children with persistent asthma who attended schools in the Northeast United States from 2008 to 2013. Participants had baseline assessments of asthma symptoms, snoring, and allergy status. Caregivers completed quarterly surveys for 12 months on symptoms of asthma, snoring, and health care outcomes. Snoring frequency (non-, rare-, sometimes-, habitual-snoring) and its relationship with asthma symptoms and asthma morbidity were assessed by mixed-effects models. RESULTS There were 1186 observations from 339 subjects. Mean age was 7.9 years; roughly half were male, and most were of minority race. Half were overweight or obese, and 65.5% had atopy. At initial snoring assessment, 24.8% reported habitual snoring, but report of snoring frequency varied over the study period. Multivariate analyses revealed increased odds of maximum asthma symptom days for habitual snoring compared with nonsnoring (1.58; 95% CI, 1.19-2.10; P < .002) and all other snoring categories. Habitual snoring was associated with greater odds of health care utilization (incidence rate ratio, 1.72; 95% CI, 1.10-2.69; P = .02) and worse asthma control (odds ratio, 1.49; 95% CI, 1.05-2.11; P = .03) compared with nonsnoring. CONCLUSIONS Snoring is common among inner-city school-age children with asthma, and habitual snoring is associated with increased asthma symptom burden and health care utilization.
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Affiliation(s)
- Sigfus Gunnlaugsson
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Mehtap Haktanir Abul
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lakiea Wright
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Perdita Permaul
- Division of Pulmonology, Allergy and Immunology, NY-Presbyterian Hospital/Weill Cornell Medicine, Weill Cornell Medical College, New York, NY
| | - Diane R Gold
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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Wei YX, Shen ZW, Yu CQ, Du HD, Lyu J, Guo Y, Bian Z, Pei P, Chen JS, Chen ZM, Li LM. [Epidemiological characteristics and correlated factors of habitual snoring among Chinese aged 30 to 79 year-old]. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40:917-923. [PMID: 31484254 DOI: 10.3760/cma.j.issn.0254-6450.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To describe the characteristics of habitual snoring among adults from 10 regions engaged in the China Kadoorie Biobank (CKB) study. Methods: The baseline survey of CKB was conducted from 2004 to 2008. Data was collected regarding the information on socio- demographic characteristics, lifestyle, sleeping habits, and results from the physical examination of the participants. Logistic regression models were used to compare the regional differences and to estimate the associations of other baseline characteristics on snoring habit. Results: A total of 512 713 participants were included in this study. The overall prevalence of habitual snoring was 21.2%, higher among men, in south regions and urban areas, but no difference observed among people with different socioeconomic status after adjusting for age, regions, BMI, waist circumference or lifestyle factors. Results showed that the prevalence of habitual snoring under the multivariable adjusted model increased among current and ever smokers, also among current and ever alcohol consumers. The risk of habitual snoring was increased by 19% per 1 kg/m(2) and 6% per 1 cm increment in BMI or waist circumference, respectively. Among participants with similar BMI, central obese individuals were more likely to be habitual snorers. For individuals with similar waist circumference, the prevalence of habitual snoring was higher among those with higher BMI. Conclusion: The prevalence of habitual snoring varied across regions. Substantial differences in habitual snoring were also seen among people with different lifestyles and body sizes.
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Affiliation(s)
- Y X Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Z W Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - C Q Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - H D Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - J Lyu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University, Beijing 100191, China
| | - Y Guo
- Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Z Bian
- Chinese Academy of Medical Sciences, Beijing 100730, China
| | - P Pei
- Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J S Chen
- China National Center for Food Safety Risk Assessment, Beijing 100022, China
| | - Z M Chen
- China National Center for Food Safety Risk Assessment, Beijing 100022, China
| | - L M Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
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Benoist LBL, Beelen AMEH, Torensma B, de Vries N. Subjective effects of the sleep position trainer on snoring outcomes in position-dependent non-apneic snorers. Eur Arch Otorhinolaryngol 2018; 275:2169-2176. [PMID: 29948269 PMCID: PMC6060761 DOI: 10.1007/s00405-018-5036-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/08/2018] [Indexed: 01/01/2023]
Abstract
Purpose To evaluate the effect of a new-generation positional device, the sleep position trainer (SPT), in non-apneic position-dependent snorers. Methods Non-apneic position-dependent snorers with an apnea–hypopnea index (AHI) < 5 events/h were included between February 2015 and September 2016. After inclusion, study subjects used the SPT at home for 6 weeks. The Snore Outcome Survey (SOS) was filled out by the subjects at baseline and after 6 weeks, and at the same time, the Spouse/Bed Partner Survey (SBPS) was filled out by their bed partners. Results A total of 36 participants were included and 30 completed the study. SOS score improved significantly after 6 weeks from 35.0 ± 13.5 to 55.3 ± 18.6, p < 0.001. SBPS score also improved significantly after 6 weeks from 24.7 ± 16.0 versus 54.5 ± 25.2, p < 0.001. The severity of snoring assessed with a numeric visual analogue scale (VAS) by the bed partner decreased significantly from a median of 8.0 with an interquartile range (IQR) of [7.0–8.5] to 7.0 [3.8–8.0] after 6 weeks (p = 0.004). Conclusions Results of this study indicate that positional therapy with the SPT improved several snoring-related outcome measures in non-apneic position-dependent snorers. The results of this non-controlled study demonstrate that this SPT could be considered as an alternative therapeutic option to improve sleep-related health status of snorers and their bed partners.
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Affiliation(s)
- L B L Benoist
- Department of Otorhinolaryngology Head and Neck surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. .,Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A M E H Beelen
- Department of Otorhinolaryngology Head and Neck surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - B Torensma
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N de Vries
- Department of Otorhinolaryngology Head and Neck surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands.,Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Kukwa W, Guilleminault C, Tomaszewska M, Kukwa A, Krzeski A, Migacz E. Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children. Int J Pediatr Otorhinolaryngol 2018; 107:37-41. [PMID: 29501308 DOI: 10.1016/j.ijporl.2018.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the prevalence of upper respiratory tract infections (URI) - as indicated by rhinosinusitis (RS), ear infections (EI), and antibiotic consumption - in a general pediatric population and evaluate the relationship between these conditions and habitual snoring and mouth breathing during sleep. METHODS A population-based cross-sectional study was performed in three medium-sized Polish cities from 2011 to 2015. RESULTS 4837/6963 questionnaires (69.5%) were completed, returned and analyzed. Mean age of studied group was 7.07 ± 0.72 and 7.14 ± 0.73 in girls and boys, respectively. Habitual mouth breathing during sleep (MB) was reported in 907 (18.7%) children and habitual snoring (HS) in 290 (6.0%). 230/290 (79.3%) of children with HS were also MB. Both HS and MB were more prevalent in boys than in girls (p = 0.027 and p < 0.0001, respectively) and neither was associated with BMI (p = 0.11 and p = 0.07, respectively). Habitual snoring and habitual mouth breathing were highly associated with more frequent bouts of rhinosinusitis, ear infections, and antibiotic use (p < 0.0001 for each parameter). CONCLUSIONS Higher rates of rhinosinusitis, ear infections, and antibiotic consumption were similarly associated with HS and MB. MB is over three times more prevalent in the pediatric population relative to HS, therefore it might be considered as a risk factor for URI and may be included in history of URI.
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Yang K, Baetzel A, Chimbira WT, Yermolina Y, Reynolds PI, Nafiu OO. Association of sleep disordered breathing symptoms with early postoperative analgesic requirement in pediatric ambulatory surgical patients. Int J Pediatr Otorhinolaryngol 2017; 96:145-151. [PMID: 28390605 PMCID: PMC5466074 DOI: 10.1016/j.ijporl.2017.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/21/2017] [Accepted: 03/16/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Sleep disordered breathing (SDB) symptoms are associated with increased rates of opioid-induced respiratory depression as well as enhanced nociception. Consequently, practitioners often withhold or administer lower intraoperative doses of opioids out of concern for postoperative respiratory depression. Therefore, SDB may be a critical determinant of analgesic requirement in the post-anesthesia care unit (PACU). We investigated whether preoperative SDB classification was independently associated with need for PACU analgesic intervention in a cross-sectional sample of 985 children who underwent elective, painful ambulatory surgical procedures. METHODS Using prospectively collected data, children aged 4-17yr were grouped into two categories based on whether or not they had symptoms of SDB. Perioperative variables were compared between the exposed and control groups using Chi-squared test for categorical or t-test for continuous variables. Logistic regression analysis was used to assess the association between SDB and the odds of requiring PACU IV opioids. RESULTS Children with preoperative SDB symptoms (N = 325) compared with the reference group of children who did not have these symptoms had higher rates of PACU analgesic intervention (47.1% vs. 37.4%; p = 0.004) and higher mean arousal pain scores (3.7 ± 3.5 vs.1.9 ± 2.9; p < 0.001). In our primary multivariable logistic regression model adjusted for a number of variables, preoperative SDB symptoms was associated with a two-fold increased odds of receiving PACU intravenous opioid (OR = 2.01, 95%CI, 1.29-3.12; p = 0.002). CONCLUSION These results suggest that preoperative SDB symptoms in children undergoing ambulatory surgery, exerts a significant influence on PACU pain behavior and analgesic requirement. Mechanisms underlying this enhanced pain experience deserve further elucidation.
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Affiliation(s)
- Kamie Yang
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Anne Baetzel
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Wilson T Chimbira
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Yuliya Yermolina
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Paul I Reynolds
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
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Gislason T, Bertelsen RJ, Real FG, Sigsgaard T, Franklin KA, Lindberg E, Janson C, Arnardottir ES, Hellgren J, Benediktsdottir B, Forsberg B, Johannessen A. Self-reported exposure to traffic pollution in relation to daytime sleepiness and habitual snoring: a questionnaire study in seven North-European cities. Sleep Med 2016; 24:93-99. [PMID: 27810192 DOI: 10.1016/j.sleep.2016.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVE/BACKGROUND Little is known about associations between traffic exposure and sleep disturbances. We examined if self-reported exposure to traffic is associated with habitual snoring and daytime sleepiness in a general population. METHODS In the RHINE III study, 12184 adults answered questions on sleep disturbances and traffic exposure. We analysed bedrooms near roads with traffic, bedrooms with traffic noise, and travelling regularly along busy roads as proxies for traffic exposures, using logistic regression. Adjustment factors were study centre, gender, age, smoking habits, educational level, body mass index, physical activity, obstructive sleep apnoea, and sleep duration. RESULTS One in ten lived near a busy road, 6% slept in a bedroom with traffic noise, and 11% travelled regularly along busy roads. Habitual snoring affected 25% and daytime sleepiness 21%. More men reported snoring and more women reported daytime sleepiness. Having a bedroom with traffic noise was associated with snoring (adjusted OR 1.29, [95% CI 1.12, 1.48]). For daytime sleepiness, on the other hand, bedroom with traffic noise and high exposure to traffic pollution have significant risk factors (adjusted ORs 1.46 [1.11, 1.92] and 1.65 [1.11, 2.45]). Results were consistent across study centres. CONCLUSIONS Daytime sleepiness is associated with traffic pollution and traffic noise, while habitual snoring is only associated with traffic noise. Self-reported traffic exposure should be taken into account when diagnosing and planning treatment for patients with sleep disturbances, because reducing noise and pollution exposure in the bedroom may have a beneficial effect.
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Affiliation(s)
- Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali - National University Hospital of Iceland, Iceland
| | - Randi J Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory-, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory-, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erna Sif Arnardottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali - National University Hospital of Iceland, Iceland
| | - Johan Hellgren
- Institute of Clinical Science, University of Gothenburg, Sweden; Department of Otorhinolaryngology, Head & Neck Surgery, Sahlgrenska Academy, Gothenburg, Sweden
| | - Bryndis Benediktsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali - National University Hospital of Iceland, Iceland
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine/Occupational & Environmental Medicine, Umeå University, Umeå, Sweden
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
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Affiliation(s)
- Min Li
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Kun Li
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Wei Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wen-Shang Hou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhen-Yu Tang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Nanchang University, Nanchang 330006, Jiangxi Province, China..
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12
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Deary V, Ellis JG, Wilson JA, Coulter C, Barclay NL. Simple snoring: not quite so simple after all? Sleep Med Rev 2014; 18:453-62. [PMID: 24888523 DOI: 10.1016/j.smrv.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/07/2014] [Accepted: 04/29/2014] [Indexed: 01/26/2023]
Abstract
Simple snoring (SS), in the absence of obstructive sleep apnoea (OSA), is a common problem, yet our understanding of its causes and consequences is incomplete. Our understanding is blurred by the lack of consistency in the definition of snoring, methods of assessment, and degree of concomitant complaints. Further, it remains contentious whether SS is independently associated with daytime sleepiness, or adverse health outcomes including cardiovascular disease and metabolic syndrome. Regardless of this lack of clarity, it is likely that SS exists on one end of a continuum, with OSA at its polar end. This possibility highlights the necessity of considering an otherwise 'annoying' complaint, as a serious risk factor for the development and progression of sleep apnoea, and consequent poor health outcomes. In this review, we: 1) highlight variation in prevalence estimates of snoring; 2) review the literature surrounding the distinctions between SS, upper airway resistance syndrome (UARS) and OSA; 3) present the risk factors for SS, in as far as it is distinguishable from UARS and OSA; and 4) describe common correlates of snoring, including cardiovascular disease, metabolic syndrome, and daytime sleepiness.
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Affiliation(s)
- Vincent Deary
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Department of Otolaryngology, Head and Neck Surgery, Newcastle University, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Nicola L Barclay
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK.
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13
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Li D, Liu D, Wang X, He D. Self-reported habitual snoring and risk of cardiovascular disease and all-cause mortality. Atherosclerosis 2014; 235:189-95. [PMID: 24854629 DOI: 10.1016/j.atherosclerosis.2014.04.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/16/2014] [Accepted: 04/27/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Inconsistent findings have reported the association between self-reported habitual snoring and risk of cardiovascular disease (CVD) and all-cause mortality. We conducted a meta-analysis to investigate whether self-reported habitual snoring was an independent predictor for CVD and all-cause mortality using prospective observational studies. METHODS Electronic literature databases (PubMed, Medline, Embase, Cochrane Library, Wanfang database, and China National Knowledge Infrastructure) were searched for publications prior to September 2013. Only prospective studies evaluating baseline habitual snoring and subsequent risk of CVD and all-cause mortality were selected. Pooled adjust hazard risk (HR) and corresponding 95% confidence intervals (CI) were calculated for categorical risk estimates. RESULTS Eight studies with 65,037 subjects were analyzed. Pooled adjust HR was 1.26 (95% CI 0.98-1.62) for CVD, 1.15 (95% CI 1.05-1.27) for coronary heart disease (CHD), and 1.26 (95% CI 1.11-1.43) for stroke comparing habitual snoring to non-snorers. Pooled adjust HR was 0.98 (95% CI 0.78-1.23) for all-cause mortality in a random effect model comparing habitual snoring to non-snorers. Habitual snoring appeared to increase greater stroke risk among men (HR 1.54; 95% CI: 1.09-2.17) than those in women (HR 1.22; 95% CI: 1.05-1.41). CONCLUSIONS Self-reported habitual snoring is a mild but statistically significant risk factor for stroke and CHD, but not for CVD and all-cause mortality. However, whether the risk is attributable to obstructive sleep apnea syndrome or snoring alone remains controversial.
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