Chest
Volume 126, Issue 3, September 2004, Pages 790-800
Journal home page for Chest

Clinical Investigations
SLEEP AND BREATHING
Risk Factors and Natural History of Habitual Snoring

https://doi.org/10.1378/chest.126.3.790Get rights and content

Study objective:

It has been suggested that habitual snoring (HS) has adverse health outcomes in children. We aimed to identify risk factors for HS and determine its natural history in primary school children.

Design:

Cross-sectional, population-based cohort study.

Setting:

Twenty-seven primary schools located within the city limits of Hannover, Germany.

Participants:

Third-grade primary school children.

Measurements and results:

Snoring frequency and potential risk factors were investigated using parental questionnaires. Unadjusted and adjusted odds ratios (ORs) for HS and their 95% confidence intervals (CIs) were calculated. One year after the initial contact, snoring status was re-evaluated in habitual snorers. In total, 1,760 children were contacted, and 1,144 parents and their children (49% were girls) agreed to participate and returned a completed questionnaire. A body mass index ≥ 90th percentile (OR, 3.5; 95% CI, 1.8 to 7.1), low maternal education (OR, 2.3; 95% CI, 1.1 to 4.7), regular daytime mouth breathing (OR, 7.4; 95% CI, 3.5 to 15.6), and a higher frequency of sore throats (OR, 17.6; 95% CI, 6.4 to 48.8) were independent risk factors for HS. Parental smoking and frequent infections were significantly but not independently associated with HS. The association of low maternal education and HS was higher in boys (OR, 4.4; 95% CI, 1.5 to 13.6; vs OR, 1.2; 95% CI, 0.4 to 3.6), while that of sore throats and HS was higher in girls (OR, 52.7; 95% CI, 6.0 to 460.2; vs OR, 13.3; 95% CI, 3.0 to 58.5). At follow-up, 39 of 80 eligible habitual snorers (48.8%) still snored regularly. Children who continued to snore differed significantly in maternal education, household smoking, snoring loudness, and prior ear, nose, throat surgery from those who had ceased to snore habitually.

Conclusions:

Socioeconomic status, obesity, signs of nasal obstruction, and pharyngeal problems were independent risk factors for HS in these primary school children. The expression of HS varied considerably over time.

Section snippets

Subjects

The recruitment strategy and basic characteristics of the study sample are described elsewhere.510 In short, 27 of 59 regular primary schools located within the city limits of Hannover, Germany were selected, using a stratified random selection procedure. Following approval by the institutional review board and the regional directorate of education, all children attending the third grade (n = 1,760) were identified. Pupils were contacted in their classrooms by two investigators, and study goals

Study Sample

Detailed information on basic characteristics of the study sample has been given elsewhere.510 In short, there were 559 girls (48.9%); mean age and body mass index (BMI) were 9.6 years (SD, 0.7) and 17.5 (SD, 2.9), respectively. Most children (n = 681; 59.5%) were 9 years old, but 213 children (18.6%) and 250 children (21.9%) were < 9 years or > 9 years old, respectively. The 75th and 90th percentiles of the BMI were 19.0 and 21.4 for the study sample, 19.5 and 21.8 for boys, and 18.5 and 20.8

Discussion

In adults, population-based cohort studies revealed age, obesity, smoking, asthma, and nasal congestion as independent risk factors for self-reported HS.16 In addition, a marked gender difference in the expression of HS and OSA was found.171819 Some studies3202122 have specifically addressed risk factors for HS in children, but none focused on gender differences. Corbo et al2021 investigated snoring in two studies with a combined sample size of 3,824 school children. These authors postulated

Conclusion

Our findings on obesity, SES, household smoking, nasal obstruction, pharyngeal problems, and frequent infections as risk factors for HS concur with others and underscore the relevance of these factors for snoring in children. Some factors cannot be modified (eg, SES), but most factors can easily be recognized and may be modified by intervention. As an example, nasal obstruction may be controlled pharmacologically (eg, nasal steroids for congestions or adenoidal hypertrophy),1639 surgically (eg,

ACKNOWLEDGMENT

The authors thank Dr. Ehrhardt (Department of Public Health, City Council, Hannover, Germany), Mrs. Martinsen (Supervisory School Authority, Hannover, Germany), Mr. Hegemann (District Government, Hannover, Germany), and the headmasters and teachers of the participating schools for their support and cooperation. Our thanks also go to the Hans Meineke Foundation (Hannover, Germany) for supporting this study, and to E. Eggebrecht and J. Wolff for their help with obtaining the questionnaires. In

References (41)

  • DS Hui et al.

    Prevalence of snoring and sleep-disordered breathing in a student population

    Chest

    (1999)
  • HI Topol et al.

    Follow-up of primary snoring in children

    J Pediatr

    (2001)
  • DJ Gottlieb et al.

    Does snoring predict sleepiness independently of apnea and hypopnea frequency?

    Am J Respir Crit Care Med

    (2000)
  • DB Teculescu et al.

    Snoring in French preschool children

    Pediatr Pulmonol

    (1992)
  • GO Owen et al.

    Snoring, apnoea and ENT symptoms in the paediatric community

    Clin Otolaryngol

    (1996)
  • MS Urschitz et al.

    Snoring, intermittent hypoxia and academic performance in primary school children

    Am J Respir Crit Care Med

    (2003)
  • S Blunden et al.

    Behavior and neurocognitive performance in children aged 5–10 years who snore compared to controls

    J Clin Exp Neuropsychol

    (2000)
  • C Guilleminault et al.

    Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning

    Eur J Pediatr

    (1982)
  • NJ Ali et al.

    Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning

    Eur J Pediatr

    (1996)
  • Schlaud M, Urschitz MS, Urschitz-Duprat PM, et al. The German study on sleep disordered breathing in primary school...
  • Cited by (129)

    • Snoring

      2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second Edition
    • SNOROSALAB: A Method Facilitating the Diagnosis of Sleep Breathing Disorders Before Polysomnography

      2022, IRBM
      Citation Excerpt :

      Partners feel the need to change their beds or rooms because of snoring. Male patients who snore have a high risk of developing OSAS in the coming 10 years [5–7]. Therefore, it continues to be a cause of morbidity and mortality for patients who cannot be diagnosed and treated effectively.

    • Disorders of Breathing During Sleep

      2019, Kendig's Disorders of the Respiratory Tract in Children
    View all citing articles on Scopus

    Pilar M. Urschitz-Duprat was supported by a research grant from the Hans Meineke Foundation, Hannover, Germany.

    This work was performed at the Department of Pediatric Pulmonology and Neonatology, Hannover Medical School.

    Currently at the Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany.

    View full text