A four year follow-up of sleep and respiratory measures in elementary school-aged children with sleep disordered breathing

Objective: Little is known of the long-term prognosis of children treated for sleep disordered breathing (SDB) and even less of children with milder forms of SDB who remain untreated. We aimed to investigate the long-term sleep and respiratory outcomes of children with a range of SDB severities. Methods: 41 children with SDB and 20 non snoring controls (mean age, 12.9 +/- 0.2 y), underwent repeat overnight polysomnography (PSG) 4.0 +/- 0.3 years after initial diagnosis. SDB severity, presence of snoring, sleep and respiratory parameters, sleep fragmentation index (SFI), the Pediatric Daytime Sleepiness Scale (PDSS), Sleep Disturbance Scale for Children (SDSC), and obstructive sleep apnea 18-item quality of life questionnaire were re assessed. Children with SDB were grouped into resolved (no snoring and obstructive apnea-hypopnea index [OAHI] <1) and unresolved (snoring or an OAHI >= 1). Results: At follow-up OAHI was reduced in both SDB groups (p < 0.05); however, 54% (n = 22) of children still continued to snore, having either persistent or new OSA (n = 4). In this unresolved group, sleep was significantly disrupted; % nonrapid eye movement stage 1 (NREM1) sleep and SFI were increased (p < 0.05), and total sleep time (TST) and sleep efficiency were decreased compared to the resolved and control groups (p < 0.05). Overall, 29% of children were treated, and of these, 67% had resolved SDB. SDB groups had higher PDSS, SDSC, and OSA-18 scores compared to controls at follow-up (p < 0.01). Conclusions: Our study demonstrated that although SDB improved in the long-term, more than 50% of children had residual SDB (mostly primary snoring) and sleep disturbance. As even mild forms of SDB are known to have adverse cardiovascular, learning, and behavioral outcomes, which have implications for the health of these children. Crown Copyright (c) 2013 Published by Elsevier B.V. All rights reserved.