Skip to main content

Main menu

  • Home
  • Content
    • Latest
    • Archive
    • home
  • Info for
    • Authors
    • Reviewers
    • Subscribers
    • Institutions
    • Advertisers
    • Join SMJ
  • About Us
    • About Us
    • Editorial Office
    • Editorial Board
  • More
    • Advertising
    • Alerts
    • Feedback
    • Folders
    • Help
  • Other Publications
    • NeuroSciences Journal

User menu

  • My alerts
  • Log in
  • Log out

Search

  • Advanced search
Saudi Medical Journal
  • Other Publications
    • NeuroSciences Journal
  • My alerts
  • Log in
  • Log out
Saudi Medical Journal

Advanced Search

  • Home
  • Content
    • Latest
    • Archive
    • home
  • Info for
    • Authors
    • Reviewers
    • Subscribers
    • Institutions
    • Advertisers
    • Join SMJ
  • About Us
    • About Us
    • Editorial Office
    • Editorial Board
  • More
    • Advertising
    • Alerts
    • Feedback
    • Folders
    • Help
  • Follow psmmc on Twitter
  • Visit psmmc on Facebook
  • RSS
Research ArticleOriginal Article
Open Access

Prevalence of obstructive sleep apnea in children with sickle cell disease at a tertiary hospital in Saudi Arabia

Tahani Al-Otaibi, Mansour Al-Qwaiee, Huda Faraidi, Fatima Batniji, Faisal Al-Otaibi and Adel Al-Harbi
Saudi Medical Journal June 2017, 38 (6) 616-620; DOI: https://doi.org/10.15537/smj.2017.6.19492
Tahani Al-Otaibi
From the Department of Pediatrics (Al-Otaibi T) King Fahd Military Medical Complex, Dhahran, and the Department of Pediatrics (Al-Qwaiee, Faraidi, Batniji, Al-Otaibi F, Al-Harbi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: [email protected]
Mansour Al-Qwaiee
From the Department of Pediatrics (Al-Otaibi T) King Fahd Military Medical Complex, Dhahran, and the Department of Pediatrics (Al-Qwaiee, Faraidi, Batniji, Al-Otaibi F, Al-Harbi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Huda Faraidi
From the Department of Pediatrics (Al-Otaibi T) King Fahd Military Medical Complex, Dhahran, and the Department of Pediatrics (Al-Qwaiee, Faraidi, Batniji, Al-Otaibi F, Al-Harbi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Fatima Batniji
From the Department of Pediatrics (Al-Otaibi T) King Fahd Military Medical Complex, Dhahran, and the Department of Pediatrics (Al-Qwaiee, Faraidi, Batniji, Al-Otaibi F, Al-Harbi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Faisal Al-Otaibi
From the Department of Pediatrics (Al-Otaibi T) King Fahd Military Medical Complex, Dhahran, and the Department of Pediatrics (Al-Qwaiee, Faraidi, Batniji, Al-Otaibi F, Al-Harbi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
RPSGT
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Adel Al-Harbi
From the Department of Pediatrics (Al-Otaibi T) King Fahd Military Medical Complex, Dhahran, and the Department of Pediatrics (Al-Qwaiee, Faraidi, Batniji, Al-Otaibi F, Al-Harbi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • References
  • PDF
Loading

Abstract

Objectives: To assess the prevalence of obstructive sleep apnea in Saudi children with sickle cell disease at a tertiary hospital in Kingdom of Saudi Arabia (KSA) using nocturnal polysomnography.

Methods: A prospective cross-section study was conducted between 2012 and 2016 in 65 children aged between 2-14 years at Prince Sultan Military Medical City, Riyadh, KSA with sickle cell disease. Patients answered a pediatric sleep questionnaire with the help of an accompanying caregiver and underwent polysomnography in the same night.

Results: The final sample included 65 children. Median age was 8.1 years. There were 32 boys (49.2%) and 33 girls (50.8%). Mean hemoglobin was 8.6 (p=0.37) and mean body mass index was 15.6 (p=0.36). The prevalence of obstructive sleep apnea was 80% (52 patients) using an apnea hypopnea index cutoff of ≥1 and 7.7% (5 patients) using an apnea hypopnea index cutoff of ≥5. Results from the pediatric sleep questionnaire were snoring (73.8%), apnea (32.8%), and bedwetting (46%).

Conclusion: Obstructive sleep apnea is common in children with sickle cell disease.

Sickle cell disease (SCD) is one of the most common inherited types of hemoglobinopathy in the Kingdom of Saudi Arabia (KSA) and has a high mortality and morbidity risk. In KSA, approximately 4.2% of the population carries the sickle cell trait and 0.3% has SCD. The highest prevalence is seen in the eastern province of the country where approximately 17% of the population has the sickle cell trait and 1.2% has SCD.1 Clinical and hematological variability exists in SCD in KSA with 2 major phenotypes, a mild phenotype and a severe phenotype.1 Sickle cell anemia is an autosomal recessive disorder characterized by the presence of homozygous HbSS or heterozygous HbS with another beta globulin mutation (for example, sickle-beta thalassemia). The hallmarks of the disease are vaso-occlusive phenomena and hemolytic anemia. Vaso-occlusive crises (VOC) can be triggered by cold, dehydration, infection, or hypoxia and can eventually result in acute chest syndromes. Nocturnal desaturation occurs in approximately 80% of patients with SCD.2,3 The underlying mechanism is thought to be secondary to intrinsic parenchymal lung disease, abnormal oxyhemoglobin affinity, and upper airway obstruction, mainly obstructive sleep apnea (OSA).4,5 The prevalence of OSA in children with SCD is reported to be 79% compared with the normal general population (1-5%).2 However, few studies that have investigated OSA prevalence in SCD children were limited to symptomatic patients only.2,6 One study, conducted a referred sample and evaluated 55 patients with SCD, found 69.1% to have obstructive sleep apnea syndrome (OSAS).6 In children with SCD, OSAS is primarily secondary to adenotonsillar hypertrophy (ATH).7 It is not understood why SCD patients are more prone to develop ATH. The main 3 hypotheses on the association include: a) compensatory hypertrophy of adenoid and tonsillar tissues after autosplenectomy; b) an increased incidence of recurrent tonsillitis due to the impaired opsonization to pathogenic bacteria; and c) extramedullary hematopoiesis.3 The presence of ATH increases the risk for OSAS, and may lead to nocturnal episodic hypoxemia, hypercarbia, and respiratory acidosis; events that can trigger red blood cell sickling and precipitate VOC.8,9 Obstructive sleep apnea syndrome is associated with various adverse health outcomes including behavioral problems, excessive day time sleepiness, cognitive deficits, cardiovascular changes, and a reduced quality of life.10 The OSAS is a treatable condition and greater effort is needed to implement and evaluate screening programs, diagnostic tools, and treatment options for OSAS in this high-risk and vulnerable population. The aim of this study was to assess the prevalence of OSA in SCD in Saudi children irrespective of sleep-related breathing disorder (SRBD) symptoms at a tertiary hospital in KSA using nocturnal polysomnography (PSG) and describe the sleep architecture in children with SCD

Methods

Ethical approval

This study was approved by the Institutional Review Board (No. 761) and was conducted in accordance with the principles contained within the Declaration of Helsinki. All patients and/or their guardians provided written informed consent.

Participants

This was a prospective cross-section study of male and female children with SCD (aged 2-14 years) referred from the hematology clinic irrespective of their SRBD symptoms between 2012 and 2016. Two-hundred patients were recruited, but only 65 patients agreed to perform overnight PSG. All patients who agreed to undergo nocturnal PSG were asked to complete a pediatric sleep questionnaire with the help of an accompanying caregiver, and demographic data and histories of medical comorbidities were collected at the same time. Inclusion criteria were patients diagnosed with SCD confirmed by hemoglobin electrophoresis and aged between 2-14 years. Exclusion criteria were patients on active therapy for OSA and patients with debilitating comorbidities.

Polysomnography

Patients were accompanied by their legal guardians for the PSG study. The study was conducted in a quiet environment, with appropriate light and temperature, for at least 6 hours. Polysomnography was conducted during spontaneous sleep. No sedation or sleep deprivation was used and patients were asked to avoid any stimulating food or drinks (coffee, black tea, chocolate, soda). The PSG was carried out in a hospital setting using a Philips Alice 6 PSG system (Alice 6 LDxS Base station INT, Philips Respironics, Murrysville, USA). All results were determined by a single observer. The following physiological parameters were recorded: electroencephalogram, leads (F3-A2, F4-A1, C3-A2, C4-A1, O1-A2, O2-A1) were placed according to the international 10-20 system, electro-oculogram, electromyogram (chin electromyography, mentalis and submentalis muscles, right and left leg electromyography, anterior tibialis muscle), electrocardiogram, airflow (signals from a nasal pressure transducer and thermistor) using Pro Tech Sensor (Pro Tech Respironics, Murrysville, USA), microphone recordings, respiratory effort (respiratory inductance plethysmography), body position, and oxygen saturation (SpO2). Sleep studies were scored by a certified sleep medicine technician according to the American Academy of Sleep Medicine (Darien, IL, USA) manual for scoring sleep stages and associated events.11 Sleepware G3 sleep diagnostic software with version 3.5.1, was used to monitor and score the acquisitions. Sleep efficiency was calculated as total sleep time divided by time in bed. Sleep latency was defined as the interval between turning off the lights and the first minute of stage 1 sleep. Rapid eye movement (REM) sleep latency was defined as the interval between sleep onset and the first period of REM sleep. Arousal was defined as an abrupt change in the frequency of the electroencephalogram for 3 seconds or longer. The total index of arousals was defined as: number of arousals divided by the total number of hours of sleep. The following definitions were used. Obstructive apnea: interruption in airflow for a duration of ≥2 respiratory cycles, despite the persistence of chest effort, abdominal effort, or a combination of chest and abdominal effort. Index of obstructive sleep apnea: the number of events per hour of sleep. Hypopnea: reduction by ≥50% in airflow amplitude associated with one arousal or reduction of >3% in relation to basal SpO2. Apnea hypopnea index (AHI): the number of obstructive apnea or obstructive hypopnea events per hour of sleep. Index of oxygen desaturation: all oxygen desaturation events >3% based on basal SpO2 per hour of sleep. Patients with an AHI ≥1 event per hour of sleep were classified as having apnea. An AHI cutoff point of ≥5 was used to compare our finding with other studies.

Pediatric sleep questionnaire

We reviewed the pediatric sleep questionnaires (PSQ) of all patients, which was translated into Arabic and completed by the accompanying caregiver. The PSQ was validated in 2000,12 and has a sensitivity of 81% and a specificity of 87%. It comprises 22 questions and is answered with either Yes, No, or Don’t know. Each Yes receives a score of 1. A score of 5 or more is a positive questionnaire.

Statistical analysis

Microsoft Excel (Microsoft Inc., Redmond, USA) was used to arrange raw data before data were imported into The Statistical Package for Social Sciences version 22 (IBM Corp., Armonk, NY, USA) version 20 for analyses. Continuous data were analyzed using analysis of variance (ANOVA) and results are reported as mean ± standard deviation. Categorical data were analyzed using the Chi squared test. Non-parametric data were analyzed using the Kruskal–Wallis test and results are reported as median and interquartile range. A p-value of ≤0.05 was considered statistically significant for associations between variables.

Results

The final sample included 65 children. Table 1 shows clinical profiles of the children with SCD in relation to AHI severity score. Median age was 8.1 years and there were 32 boys (49.2%) and 33 girls (50.8%). Of the patients studied, 90.8% had sickle cell anemia. At AHI cutoff points of ≥1 and ≥5, the male to female ratios were 1:1 (26 boys [50%] and 26 girls [50%] and 1.5:1 (3 boys [60%] and 2 girls [40%]), respectively. There was no significant gender predominance. Sixty percent of SCD patients had a history of blood transfusions; however, there was no significant association with OSA (p=0.07). Results from the pediatric sleep questionnaire showed a history of snoring for more than half the time during sleep in 73.8% children (of these 64.6% had an AHI≥1). A history of apnea during sleep was reported in 32.8%(71.4% had an AHI≥1), and bedwetting was reported in 46%(62.1% had an AHI ≥1).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 1

Demographic distribution and medical history by apnea hypopnea index categories.

The distribution of cardiopulmonary PSG data stratified by AHI cutoff is shown in Table 2. The frequency of OSA in the sample, based on commonly used AHI cutoff points and definitions, was 80% (52 patients) if using an AHI cutoff point of ≥1 and 7.7% (5 patients) if using an AHI cutoff point of ≥5. Table 3 shows sleep PSG data divided by age (≤5, 6-10, and ≥11 years).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 2

Cardiorespiratory polysomnography variables by apnea hypopnea index cutoff points among 65 children.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 3

Sleep polysomnography variables by age in yearsamong 65 children.

Discussion

The prevalence of OSA in SCD patients screened for OSA irrespective of SRBD symptoms was 80% at an AHI cutoff point of ≥1 and 7.7% at a cutoff point of ≥5 in the current study. Our results for OSA prevalence were significantly higher than those of the normal population (1–5%).10,13,14 In children with SCD, the reported OSA prevalence irrespective of SRBD symptoms ranges between 10% and 41%.3,15 The high prevalence of OSA in SCD patients in the current study might be secondary to ethnic diversity. Bahammam et al16,17 reported that 4 in 10 middle-aged Saudi women and one in 3 middle-aged Saudi males are at risk for OSA. Studies in pediatric population are limited.

Cigarette smoke exposure18 and previous adenotonsillectomy,19 both known to be associated with OSAS in the general population, were not significantly associated with OSA in this study. We found no significant association between OSA and asthma. However, our asthma assessment did not include a physician’s diagnosis, but was inferred from parents’ descriptions of asthma symptoms in their children.

Nocturnal oxygen desaturation in patients with sickle cell disorders ranges between 50%20,21 and 80%,2,3 and is associated with an increase in red blood cell sickling and increased VOC and acute chest syndromes. In the current study, nocturnal oxygen desaturation reached 72.7%, consistent with what is reported in the literature.2,3 Also, the arousal index was high in the severe AHI group. Our second aim was to describe sleep architecture in children with SCD, but we could not draw conclusions from the findings for sleep stages in the current study due to the small sample size, which made it difficult to compare the patients in the 3 age groups. Future local studies with larger sample sizes are needed to describe the sleep stages by age groups in SCD patients. A strength of the current study was that we studied children with SCD irrespective of their SRBD symptoms.

Study limitations

There was a large variation in ages in our sample and there were both patients with sickle cell anemia and sickle beta-thalassemia, in addition to small sample size. Our sample comprised patients referred from a specialized clinic at a tertiary hospital and might not reflect the actual population of SCD patients in the community.

In conclusion, in the setting of a Saudi tertiary hospital, OSA is very common in children with SCD. Appropriate care of these patients should include routine evaluation for OSAS to improve overall health and prevent possible OSAS-related complications.

Footnotes

  • Disclosure. Authors have no conflict of interest, and the work was not supported or funded by any drug company. Dr. Adel Al-Harbi is a member of the Editorial Team, and was therefore excluded from any final editorial decisions regarding this paper.

  • Received February 20, 2017.
  • Accepted March 27, 2017.
  • Copyright: © Saudi Medical Journal

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

  1. ↵
    1. Jastaniah W
    (2011) Epidemiology of sickle cell disease in Saudi Arabia. Ann Saudi Med 31:289–293.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Kaleyias J,
    2. Mostofi N,
    3. Grant M,
    4. Coleman C,
    5. Luck L,
    6. Dampier C,
    7. et al.
    (2008) Severity of obstructive sleep apnea in children with sickle cell disease. J Pediatr Hematol Oncol 30:659–665.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Salles C,
    2. Ramos RT,
    3. Daltro C,
    4. Barral A,
    5. Marinho JM,
    6. Matos MA
    (2009) Prevalence of obstructive sleep apnea in children and adolescents with sickle cell anemia. J Bras Pneumol 35:1075–1083.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Caboot JB,
    2. Allen JL
    (2008) Pulmonary complications of sickle cell disease in children. Curr Opin Pediatr 20:279–287.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Needleman JP,
    2. Franco ME,
    3. Varlotta L,
    4. Reber-Brodecki D,
    5. Bauer N,
    6. Dampier C,
    7. et al.
    (1999) Mechanisms of nocturnal oxyhemoglobin desaturation in children and adolescents with sickle cell disease. Pediatr Pulmonol 28:418–422.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Rogers VE,
    2. Lewin DS,
    3. Winnie GB,
    4. Geiger-Brown J
    (2010) Polysomnographic characteristics of a referred sample of children with sickle cell disease. J Clin Sleep Med 6:374–381.
    OpenUrlPubMed
  7. ↵
    1. Guilleminault C
    (1987) Obstructive sleep apnea syndrome and its treatment in children: areas of agreement and controversy. Pediatr Pulmonol 3:429–436.
    OpenUrlCrossRefPubMed
  8. ↵
    1. Maddern BR,
    2. Reed HT,
    3. Ohene-Frempong K,
    4. Beckerman RC
    (1989) Obstructive sleep apnea syndrome in sickle cell disease. Ann Otol Rhinol Laryngol 98:174–178.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Brooks LJ,
    2. Koziol SM,
    3. Chiarucci KM,
    4. Berman BW
    (1996) Does sleep-disordered breathing contribute to the clinical severity of sickle cell anemia? J Pediatr Hematol Oncol 18:135–139.
    OpenUrlCrossRefPubMed
  10. ↵
    1. Marcus CL,
    2. Brooks LJ,
    3. Draper KA,
    4. Gozal D,
    5. Halbower AC,
    6. Jones J,
    7. et al.
    (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130:e714–e755.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Berry RB,
    2. Budhiraja R,
    3. Gottlieb DJ,
    4. Gozal D,
    5. Iber C,
    6. Kapur VK,
    7. et al.
    (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619.
    OpenUrlCrossRefPubMed
  12. ↵
    1. Chervin RD,
    2. Hedger K,
    3. Dillon JE,
    4. Pituch KJ
    (2000) Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep medicine 1:21–32.
    OpenUrlCrossRefPubMed
  13. ↵
    1. Bixler EO,
    2. Vgontzas AN,
    3. Lin HM,
    4. Liao D,
    5. Calhoun S,
    6. Vela-Bueno A,
    7. et al.
    (2009) Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 32:731–736.
    OpenUrlPubMed
  14. ↵
    1. Rosen CL,
    2. Larkin EK,
    3. Kirchner HL,
    4. Emancipator JL,
    5. Bivins SF,
    6. Surovec SA,
    7. et al.
    (2003) Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr 142:383–389.
    OpenUrlCrossRefPubMed
  15. ↵
    1. Rosen CL,
    2. Debaun MR,
    3. Strunk RC,
    4. Redline S,
    5. Seicean S,
    6. Craven DI,
    7. et al.
    (2014) Obstructive sleep apnea and sickle cell anemia. Pediatrics 134:273–281.
    OpenUrlAbstract/FREE Full Text
  16. ↵
    1. Bahammam AS,
    2. Al-Rajeh MS,
    3. Al-Ibrahim FS,
    4. Arafah MA,
    5. Sharif MM
    (2009) Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi women in primary care. Saudi Med J 30:1572–1526.
    OpenUrlPubMed
  17. ↵
    1. BaHammam AS,
    2. Alrajeh MS,
    3. Al-Jahdali HH,
    4. BinSaeed AA
    (2008) Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi males in primary care. Saudi Med J 29:423–436.
    OpenUrlPubMed
  18. ↵
    1. Weinstock TG,
    2. Rosen CL,
    3. Marcus CL,
    4. Garetz S,
    5. Mitchell RB,
    6. Amin R,
    7. et al.
    (2014) Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates. Sleep 37:261–269.
    OpenUrlCrossRefPubMed
  19. ↵
    1. Morton S,
    2. Rosen C,
    3. Larkin E,
    4. Tishler P,
    5. Aylor J,
    6. Redline S
    (2001) Predictors of sleep-disordered breathing in children with a history of tonsillectomy and/or adenoidectomy. Sleep 24:823–839.
    OpenUrlPubMed
  20. ↵
    1. Setty BN,
    2. Stuart MJ,
    3. Dampier C,
    4. Brodecki D,
    5. Allen JL
    (2003) Hypoxaemia in sickle cell disease: biomarker modulation and relevance to pathophysiology. Lancet 362:1450–1455.
    OpenUrlCrossRefPubMed
  21. ↵
    1. Quinn CT,
    2. Ahmad N
    (2005) Clinical correlates of steady-state oxyhaemoglobin desaturation in children who have sickle cell disease. Br J Haematol 131:129–134.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Saudi Medical Journal: 38 (6)
Saudi Medical Journal
Vol. 38, Issue 6
1 Jun 2017
  • Table of Contents
  • Cover (PDF)
  • Index by author
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on Saudi Medical Journal.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Prevalence of obstructive sleep apnea in children with sickle cell disease at a tertiary hospital in Saudi Arabia
(Your Name) has sent you a message from Saudi Medical Journal
(Your Name) thought you would like to see the Saudi Medical Journal web site.
Citation Tools
Prevalence of obstructive sleep apnea in children with sickle cell disease at a tertiary hospital in Saudi Arabia
Tahani Al-Otaibi, Mansour Al-Qwaiee, Huda Faraidi, Fatima Batniji, Faisal Al-Otaibi, Adel Al-Harbi
Saudi Medical Journal Jun 2017, 38 (6) 616-620; DOI: 10.15537/smj.2017.6.19492

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Prevalence of obstructive sleep apnea in children with sickle cell disease at a tertiary hospital in Saudi Arabia
Tahani Al-Otaibi, Mansour Al-Qwaiee, Huda Faraidi, Fatima Batniji, Faisal Al-Otaibi, Adel Al-Harbi
Saudi Medical Journal Jun 2017, 38 (6) 616-620; DOI: 10.15537/smj.2017.6.19492
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Prevalence of obstructive sleep apnea in children with sickle cell disease at a tertiary hospital in Saudi Arabia
  • Google Scholar

More in this TOC Section

  • Longitudinal analysis of foodborne disease outbreaks in Saudi Arabia
  • Psychological stress and its association with bronchial asthma in Saudi Arabia
  • The factors affecting comfort and the comfort levels of patients hospitalized in the coronary intensive care unit
Show more Original Article

Similar Articles

CONTENT

  • home

JOURNAL

  • home

AUTHORS

  • home
Saudi Medical Journal

© 2025 Saudi Medical Journal Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention.  Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.

Powered by HighWire