Download PDF
Sleep Breath 2003; 07(4): 167-176
DOI: 10.1055/s-2003-814762
ORIGINAL ARTICLE

Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Symptoms of Sleep Breathing Disorders in Children Are Underreported by Parents at General Practice Visits

Sarah Blunden1 , Kurt Lushington1,2 , Berndt Lorenzen3 , Johnny Wong3 , R. Balendran3 , Declan Kennedy4
  • 1Centre for Sleep Research, Queen Elizabeth Hospital, Woodville, South Australia
  • 2School of Psychology, University of South Australia, Adelaide, South Australia
  • 3Adelaide Northern Division of General Practice, Elizabeth, South Australia
  • 4University of Adelaide, Department of Respiratory Medicine/Pediatrics, Women's and Children's Hospital, North Adelaide, South Australia
Further Information

Publication History

Publication Date:
07 January 2004 (online)

    Permissions and Reprints

ABSTRACT

Sleep breathing disorders (SBD) in children are reportedly underdiagnosed in general practice. A contributory factor may be parental underreporting of symptoms. This possibility was examined by comparing the frequency with which snoring was mentioned at general practitioner visits by parents with frequency that snoring was reported on questionnaire evaluation immediately prior to consultation. We also examined the effects of age and gender on SBD symptoms. Parents of 626 children aged 0 to 16 years attending their general practitioner for sick child visits completed selected items from the Sleep Disturbance Scale for Children and the Obstructive Sleep Apnea Syndrome Expanded Childhood Questionnaire. Parents and general practitioners were also asked if snoring was discussed at the current consultation visit or at a prior consultation visit in the previous 12 months. Eighteen percent (112 of 626) of children were frequent snorers (more than three times per week), whereas 0.6 to 5.0% of children snored and had one or more additional SBD symptom suggestive of obstructive sleep apnea. SBD symptoms tended to peak in early to middle childhood with few gender differences. We found that snoring was patently underreported by parents. In the children with a history of frequent snoring on questionnaire evaluation and where the reason for the consultation visit was documented, snoring was mentioned by parents at the current consultation visit in only 8% (8 of 100) of cases and at a prior consultation visit in only 15% (15 of 100) of cases. The present findings support a need for increased parental education regarding the symptoms and clinical significance of SBD.

KEYWORDS

Snoring - sleep breathing disorders - children - general practitioners

REFERENCES

  • 1 Levy A M, Tabakin B S, Hanson J S, Narkewicz R M. Hypertrophied adenoids causing pulmonary hypertension and severe congestive heart failure.  N Engl J Med . 1967;  277 506-511
    PubMedGoogle Scholar
  • 2 Guilleminault C, Eldridge F L, Simmons F B, Dement W C. Sleep apnea in eight children.  Pediatrics . 1976;  58 23-30
    PubMedGoogle Scholar
  • 3 Guilleminault C, Winkle R, Korobkin R, Simmons B. Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning.  Eur J Pediatr . 1982;  139 165-171
    CrossrefPubMedGoogle Scholar
  • 4 Brouillette R T, Fernbach S K, Hunt C E. Obstructive sleep apnea in infants and children.  J Pediatr . 1982;  100 31-40
    PubMedGoogle Scholar
  • 5 Tal A, Leiberman A, Margulis G, Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment.  Pediatr Pulmonol . 1988;  4 139-143
    PubMedGoogle Scholar
  • 6 Stradling J R, Thomas G, Warley A R, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children.  Lancet . 1990;  335 249-253
    CrossrefPubMedGoogle Scholar
  • 7 Weissbluth M, Davis A T, Poncher J, Reiff J. Signs of airway obstruction during sleep and behavioral, developmental, and academic problems.  J Dev Behav Pediatr . 1983;  4 119-121
    PubMedGoogle Scholar
  • 8 Ali N J, Pitson D, Stradling J R. Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning.  Eur J Pediatr . 1996;  155 56-62
    CrossrefPubMedGoogle Scholar
  • 9 Ali N J, Pitson D J, Stradling J R. Snoring, sleep disturbance, and behaviour in 4-5 year olds.  Arch Dis Child . 1993;  68 360-366
    CrossrefPubMedGoogle Scholar
  • 10 Blunden S, Lushington K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls.  J Clin Exp Neuropsychol . 2000;  22 554-568
    CrossrefPubMedGoogle Scholar
  • 11 Gozal D. Sleep-disordered breathing and school performance in children.  Pediatrics . 1998;  102 616-620
    CrossrefPubMedGoogle Scholar
  • 12 Owens J, Spirito A, Marcotte A, McGuinn M, Berkelhammer L. Neuropsychological and behavioral correlates of obstructive sleep apnea syndrome in children: a preliminary study.  Sleep Breath . 2000;  4 67-78
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Rhodes S K, Shimoda K C, Waid L R. et al . Neurocognitive deficits in morbidly obese children with obstructive sleep apnea.  J Pediatr . 1995;  127 741-744
    PubMedGoogle Scholar
  • 14 Gozal D, Pope Jr W D. Snoring during early childhood and academic performance at ages thirteen to fourteen years.  Pediatrics . 2001;  107 1394-1399
    CrossrefPubMedGoogle Scholar
  • 15 Corbo G M, Fuciarelli F, Foresi A, De Benedetto F. Snoring in children: association with respiratory symptoms and passive smoking.  BMJ . 1989;  299 1491-1494
    PubMedGoogle Scholar
  • 16 Gislason T, Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence.  Chest . 1995;  107 963-966
    CrossrefPubMedGoogle Scholar
  • 17 Hultcrantz E, Lofstrand-Tidestrom B, Ahlquist-Rastad J. The epidemiology of sleep related breathing disorder in children.  Int J Pediatr Otorhinolaryngol . 1995;  32(Suppl) S63-S66
    CrossrefPubMedGoogle Scholar
  • 18 Anuntaseree W, Rookkapan K, Kuasirikul S, Thongsuksai P. Snoring and obstructive sleep apnea in Thai school-age children: prevalence and predisposing factors.  Pediatr Pulmonol . 2001;  32 222-227
    CrossrefPubMedGoogle Scholar
  • 19 Owen G O, Canter R J, Robinson A. Snoring, apnoea and ENT symptoms in the paediatric community.  Clin Otolaryngol . 1996;  21 130-134
    PubMedGoogle Scholar
  • 20 Teculescu D B, Caillier I, Perrin P, Rebstock E, Rauch A. Snoring in French preschool children.  Pediatr Pulmonol . 1992;  13 239-244
    PubMedGoogle Scholar
  • 21 Brunetti L, Rana S, Lospalluti M L. et al . Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy.  Chest . 2001;  120 1930-1935
    CrossrefPubMedGoogle Scholar
  • 22 Chervin R D, Archbold K H, Panahi P, Pituch K J. Sleep problems seldom addressed at two general pediatric clinics.  Pediatrics . 2001;  107 1375-1380
    CrossrefPubMedGoogle Scholar
  • 23 Owens J A. The practice of pediatric sleep medicine: results of a community survey.  Pediatrics . 2001;  108 E51
    CrossrefPubMedGoogle Scholar
  • 24 Rosen R, Zozula R. Education and training in the field of sleep medicine.  Curr Opin Pulm Med . 2000;  6 512-518
    PubMedGoogle Scholar
  • 25 Rosen R C, Zozula R, Jahn E G, Carson J L. Low rates of recognition of sleep disorders in primary care: comparison of a community-based versus clinical academic setting.  Sleep Med . 2001;  2 47-55
    PubMedGoogle Scholar
  • 26 Archbold K H, Pituch K J, Panahi P, Chervin R D. Symptoms of sleep disturbances among children at two general pediatric clinics.  J Pediatr . 2002;  140 97-102
    CrossrefPubMedGoogle Scholar
  • 27 Corbo G M, Forastiere F, Agabiti N. et al . Snoring in 9- to 15-year-old children: risk factors and clinical relevance.  Pediatrics . 2001;  108 1149-1154
    CrossrefPubMedGoogle Scholar
  • 28 Smedje H, Broman J E, Hetta J. Parents' reports of disturbed sleep in 5-7-year-old Swedish children.  Acta Paediatr . 1999;  88 858-865
    CrossrefPubMedGoogle Scholar
  • 29 Ferreira A M, Clemente V, Gozal D. et al . Snoring in Portuguese primary school children.  Pediatrics . 2000;  106 E64
    CrossrefPubMedGoogle Scholar
  • 30 Stein M A, Mendelsohn J, Obermeyer W H, Amromin J, Benca R. Sleep and behavior problems in school-aged children.  Pediatrics . 2001;  107 E60
    CrossrefPubMedGoogle Scholar
  • 31 Bruni O, Ottaviano S, Guidetti V. et al . The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence.  J Sleep Res . 1996;  5 251-261
    CrossrefPubMedGoogle Scholar
  • 32 Brouillette R, Hanson D, David R. et al . A diagnostic approach to suspected obstructive sleep apnea in children.  J Pediatr . 1984;  105 10-14
    PubMedGoogle Scholar
  • 33 Scher A, Epstein R, Sadeh A, Tirosh E, Lavie P. Toddlers' sleep and temperament: reporting bias or valid link.  J Child Psychol Psychiatry . 1992;  33 1249-1254
    PubMedGoogle Scholar
  • 34 Archbold K H, Pituch K J, Panahi P, Chervin R D. Symptoms of sleep disturbances among children at two general pediatric clinics.  J Pediatr . 2002;  140 97-102
    CrossrefPubMedGoogle Scholar
  • 35 Namen A M, Landry S H, Case L D, McCall W V, Dunagan D P, Haponik E F. Sleep histories are seldom documented on a general medical service.  South Med J . 2001;  94 874-879
    PubMedGoogle Scholar
  • 36 Mindell J A, Durand V M. Treatment of childhood sleep disorders: generalization across disorders and effects on family members.  J Pediatr Psychol . 1993;  18 731-750
    PubMedGoogle Scholar
  • 37 Sateia M J, Owens J, Dube C, Goldberg R. Advancement in sleep medicine education.  Sleep . 2000;  23 1021-1023
    PubMedGoogle Scholar
  • 38 Carroll J L, McColley S A, Marcus C L, Curtis S, Loughlin G M. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children.  Chest . 1995;  108 610-618
    CrossrefPubMedGoogle Scholar
  • 39 Kwok K L, Ng D K, Cheung Y F. BP and arterial distensibility in children with primary snoring.  Chest . 2003;  123 1561-1566
    CrossrefPubMedGoogle Scholar
  • 40 Goldstein N A, Post J C, Rosenfeld R M, Campbell T F. Impact of tonsillectomy and adenoidectomy on child behavior.  Arch Otolaryngol Head Neck Surg . 2000;  126 494-498
    PubMedGoogle Scholar
  • 41 Camhi S L, Morgan W J, Pernisco N, Quan S F. Factors affecting sleep disturbances in children and adolescents.  Sleep Med . 2000;  1 117-123
    PubMedGoogle Scholar
  • 42 Guilleminault C, Partinen M, Praud J P, Quera-Salva M A, Powell N, Riley R. Morphometric facial changes and obstructive sleep apnea in adolescents.  J Pediatr . 1989;  114 997-999
    PubMedGoogle Scholar
  • 43 Engleman H, Joffe D. Neuropsychological function in obstructive sleep apnea.  Sleep Med Rev . 1999;  3 59-78
    CrossrefPubMedGoogle Scholar
      >