Original Articles
Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity*,**

https://doi.org/10.1067/mpd.2003.28Get rights and content

Abstract

Objectives To evaluate the extent to which sleep-disordered breathing (SDB) varies with putative demographic and medical risk factors and to estimate the prevalence of undiagnosed SDB. Study design Prospective, cross-sectional study in a population-based cohort of 850 children (41% black, 46% preterm), 8 to 11 years of age. Participants' caretakers completed questionnaires about health and sleep. Children underwent overnight in-home cardiorespiratory recordings of airflow, respiratory effort, oximetry, and electrocardiography. SDB was identified by respiratory disturbance indices commonly applied in clinical practice. Risk factors were estimated by logistic regression. Prevalence was derived from cohort-specific estimates with birth weights from US live births data. Results Using the most inclusive definition, SDB was detected in 40 (4.7%) participants, with prevalence varying widely across population subsets. Depending on the definition used, SDB was 4 to 6 times more likely in black children compared with white children and almost 3 to 5 times more likely in former preterm compared with term children. The estimated population prevalence of SDB was 2.2% (95% CI, 1.2%, 3.2%). Conclusions SDB is a relatively common condition in 8- to 11-year-old children. Potentially vulnerable subgroups, black children, and former preterm infants, are at increased risk.

Section snippets

Study sample

The CCSHS is a population-based cohort of 907 children studied at 8 to 11 years of age. The study used questionnaires about sleep, breathing, and general health, in-home overnight cardiorespiratory studies, and other physiologic, neuropsychologic, and behavioral assessments (latter data are not presented here). This cohort was assembled as a stratified random sample of full-term and preterm children who were born between 1988 and 1993 and identified from the birth records of three Cleveland

Results

A total of 850 (94%) of the CCSHS cohort had both questionnaire data and technically satisfactory home recordings (Table I).The mean gestational age of the former preterm participants was 31 ± 3 weeks, and 17% of the sample had birth weights <1000 g. Although the preterm sample was slightly younger, shorter, and weighed less, both groups were comparable with respect to race, sex, and obesity. Snoring and prior tonsillectomy or adenoidectomy were reported more commonly in the preterm group.

Discussion

This study presents fundamental epidemiologic data on childhood SDB, quantifying the prevalence of unrecognized SDB and the association of several putative risk factors with childhood SDB. We conducted objective cardiorespiratory monitoring during sleep in the largest population-based sample of US children that included substantial black representation. In addition, the targeted population had a high participation rate that minimized selection biases. We observed a wide spectrum of undiagnosed

Acknowledgements

We are grateful for the excellent and invaluable assistance of Jean Arnold, Najla Golebiewski, Greg Graham, Tangela Powell, Heather Rosebrock, Andrew South, and Dina Tell, who diligently recruited the patients, collected or analyzed the data, and maintained the enthusiasm of the cohort in this ongoing study. We thank Dr Mark Schluchter for biostatistical assistance with the study design and review of the manuscript. Finally, we are most indebted to members of the cohort, who so generously

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  • Cited by (0)

    *

    Supported by grants RO1HL60957, K23 HL04426, RO1 NR02707, and M01 Rrmpd0380-39 from the National Institutes of Health.

    **

    Reprint requests: Carol L. Rosen, MD, Department of Pediatrics, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, RB&C 790 Mail Stop 6003, Cleveland, OH 44106-6003.

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