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KARADAĞ, BÜLENT TANER

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Author: ARMAN, AYŞE × Subject: children ×

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    Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in Istanbul
    (AMER COLL CHEST PHYSICIANS, 2004) ARMAN, AYŞE; Ersu, R; Arman, AR; Save, D; Karadag, B; Karakoc, F; Berkem, M; Dagli, E
    Study objectives: Snoring during sleep is an important manifestation of obstructive sleep apnea syndrome (OSAS). Although clinical history is not sufficiently sensitive and specific to distinguish primary snoring from OSAS, snoring is indicative of upper airway obstruction and may be associated with the presence of diurnal symptoms. Our study aims were to determine the prevalence of snoring in primary school children in Istanbul, and to evaluate the diurnal symptoms and conditions that may be associated with sleep problems. Design, setting, and subjects: A parental questionnaire was used to assess the sleep and wake behavioral patterns in children. Eight representative schools in each of 9 school districts randomly selected from the 32 school districts in Istanbul were visited. Results: The response rate was 78.1%; 2,147 of 2,746 questionnaires were fully completed, returned, and analyzed. The prevalence of habitual snoring was 7.0%. Habitual snorers had significantly more nighttime symptoms, such as observed apneas (odds ratio [OR], 16.9; 95% confidence interval [CI], 10.0 to 28.8; p < 0.0001), difficulty breathing (OR, 17.8; CI, 10.9 to 29.2; p < 0.0001), restless sleep, parasomnias, and nocturnal enuresis, compared to occasional and nonsnorers. There were also increased prevalence of daytime symptoms, such as falling asleep while watching television (OR, 1.8; CI, 0.9 to 3.7; p = 0.01) and in public places (OR, 2.1; CI, 1.2 to 3.8; p = 0.03), and hyperactivity (OR, 2.7; CI, 1.8 to 3.9; p < 0.0001). Exposure to cigarette smoke and the presence of asthma and hay fever increased the likelihood of habitual snoring. Children with a higher risk for OSAS (habitual snoring, apnea, and difficulty breathing during sleep) were also compared to nonsnorers. Although nighttime symptoms were more likely in the high-risk group, the risk of daytime symptoms increased as well. Conclusions: Habitual snoring is a significant problem for children and may be associated with diurnal symptoms. Exposure to cigarette smoke at home and the presence of asthma and hay fever increase the likelihood of habitual snoring.
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    Symptoms of inattention and hyperactivity in children with habitual snoring: evidence from a community-based study in Istanbul
    (WILEY, 2005) ARMAN, AYŞE; Arman, AR; Ersu, R; Save, D; Karadag, B; Karaman, G; Karabekiroglu, K; Karakoc, F; Dagli, E; Berkem, M
    Background: Neurobehavioural symptoms of inattention and hyperactivity are common in children with sleep-disordered breathing (SDB). Prevalence rates of habitual snoring and attention deficit hyperactivity disorder (ADHD) are very similar and both have a substantial negative effect on children's behavioural health. Objective: We examined the differences for subjective attentional and hyperactivity measures reported by parents and teachers among primary school children with habitual snoring and age- and sex-matched controls in a community-based case-control study in Istanbul. Methods: In 2002, a survey was carried out to determine the prevalence of snoring in 2147 primary school children. After one year, in 2003, 151 children with habitual snoring and 302 controls from this survey were studied with parental SDB questionnaire, Conners' Parent (Conners-P) and Teacher Scales, and an inattention hyperactivity scale (IHS). Exclusion criteria included history of ADHD diagnosis, controls who started to snore and habitual snorers (HS) who no longer snored in this follow-up study. Results: Ninety-six HS and 190 control subjects (mean age: 9.4 +/- 1.3) were evaluated. HS had significantly more symptoms of hyperactivity (Conners-ADHD index) (P: 0.033), attentional (P: 0.019), and conduct and oppositional defiant in subscales (P: 0.001) of Conners-P and IHS-Parents. A pooled score of Conners-P ADHD Index > 60 and IHS-Parent score > 1.25 showed considerable difference in HS when compared with controls (5.1% vs. 1.4%) (P < 0.0001). Daytime hyperactivity and excessive daytime sleepiness reported by parents correlated with scores of Conners-P and IHS-P (P < 0.01). Teachers' observations showed significant correlations with learning disability and the level of academic performance in HS (P < 0.01). Other behavioural parameters related to SDB were not significantly correlated with teachers' ADHD ratings in HS. Conclusions: Increased rates of moderate hyperactivity as well as conduct and oppositional defiant symptoms in HS reported by the parents might reflect a negative impact on overall neurobehavioural health. The teachers' scores yielded no significant results among HS and controls. This may be caused by the limitation due to shared method variance. The negative effect of crowded classes on teachers' evaluations must be also taken into consideration. After exclusion of a diagnosis of ADHD in children presenting with hyperactivity and inattention, children with habitual snoring with prominent scores of behavioural measures should be considered as candidates for further assessment by a sleep specialist.