Skip to main content
SpringerLink
Log in

Primary snoring in school children: prevalence and neurocognitive impairments

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

We aimed to investigate the prevalence of primary snoring (PS) and its association with neurocognitive impairments.

Methods

Data from a community-based study in 1,114 primary school children were used to identify children who never (N = 410) or habitually snored (N = 114). In order to separate children with PS from those with upper airway resistance syndrome (UARS) or obstructive sleep apnoea (OSA), home polysomnography was conducted in all habitually snoring children. Neurocognitive impairments and poor school performance were compared between children who never snored, PS, and UARS/OSA.

Results

Polysomnography was successfully conducted in 92 habitual snorers. Of these, 69 and 23 had PS and UARS/OSA, respectively. Prevalence [95% confidence interval (95% CI)] of PS was 6.1% (4.5–7.7). Compared to children who had never snored, children with PS had more hyperactive (39% vs. 20%) and inattentive behaviour (33% vs. 11%), as well as poor school performance in mathematics (29% vs. 16%), science (23% vs. 12%), and spelling (33% vs. 20%; all P values <0.05). PS was a significant risk factor (odds ratio; 95% CI) for hyperactive behaviour (2.8; 1.6–4.8), inattentive behaviour (4.4; 2.4–8.1), as well as daytime sleepiness (10.7; 4.0–28.4). PS was also an independent risk factor for poor school performance in mathematics (2.6; 1.2–5.8), science (3.3; 1.2–8.8), and spelling (2.5; 1.1–5.5). Odds ratios throughout were similar to the UARS/OSA group.

Conclusions

Children with non-hypoxic, non-apnoeic PS may exhibit significant neurocognitive impairments. Consequences may be similar to those associated with UARS or OSA. If confirmed, PS is not “benign” and may require treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Marcus CL (2001) Sleep-disordered breathing in children. Am J Respir Crit Care Med 164:16–30

    PubMed  CAS  Google Scholar 

  2. American Thoracic Society (1996) Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 153:866–878

    Google Scholar 

  3. American Academy of Pediatrics, Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome (2002) Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 109:704–712

    Article  Google Scholar 

  4. Kennedy JD, Blunden S, Hirte C, Parsons DW, Martin AJ, Crowe E, Williams D, Pamula Y, Lushington K (2004) Reduced neurocognition in children who snore. Pediatr Pulmonol 37:330–337

    Article  PubMed  CAS  Google Scholar 

  5. Blunden S, Lushington K, Kennedy D, Martin J, Dawson D (2000) Behavior and neurocognitive performance in children aged 5–10 years who snore compared to controls. J Clin Exp Neuropsychol 22:554–568

    Article  PubMed  CAS  Google Scholar 

  6. O'Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, Raffield TJ, Gozal D (2004) Neurobehavioral implications of habitual snoring in children. Pediatrics 114:44–49

    Article  PubMed  Google Scholar 

  7. Urschitz MS, Eitner S, Guenther A, Eggebrecht E, Wolff J, Urschitz-Duprat PM, Schlaud M, Poets CF (2004) Habitual snoring, intermittent hypoxia, and impaired behavior in primary school children. Pediatrics 114:1041–1048

    Article  PubMed  Google Scholar 

  8. Gozal D, Daniel JM, Dohanich GP (2001) Behavioral and anatomical correlates of chronic episodic hypoxia during sleep in the rat. J Neurosci 21:2442–2450

    PubMed  CAS  Google Scholar 

  9. O'Brien LM, Gozal D (2002) Behavioural and neurocognitive implications of snoring and obstructive sleep apnoea in children: facts and theory. Paediatr Respir Rev 3:3–9

    Article  PubMed  Google Scholar 

  10. Gottlieb DJ, Yao Q, Redline S, Ali T, Mahowald MW (2000) Does snoring predict sleepiness independently of apnea and hypopnea frequency? Am J Respir Crit Care Med 162:1512–1517

    PubMed  CAS  Google Scholar 

  11. Urschitz MS, Guenther A, Eggebrecht E, Wolff J, Urschitz-Duprat PM, Schlaud M, Poets CF (2003) Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med 168:464–468

    Article  PubMed  Google Scholar 

  12. Montgomery-Downs HE, Gozal D (2006) Snore-associated sleep fragmentation in infancy: mental development effects and contribution of secondhand cigarette smoke exposure. Pediatrics 117:e496–e502

    Article  PubMed  Google Scholar 

  13. Beebe DW, Gozal D (2002) Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res 11:1–16

    Article  PubMed  Google Scholar 

  14. Blunden S, Lushington K, Lorenzen B, Martin J, Kennedy D (2005) Neuropsychological and psychosocial function in children with a history of snoring or behavioral sleep problems. J Pediatr 146:780–786

    Article  PubMed  Google Scholar 

  15. Schlaud M, Urschitz MS, Urschitz-Duprat PM, Poets CF (2004) The German study on sleep-disordered breathing in primary school children: epidemiological approach, representativeness of study sample, and preliminary screening results. Paediatr Perinat Epidemiol 18:431–440

    Article  PubMed  Google Scholar 

  16. Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105:10–14

    Article  PubMed  CAS  Google Scholar 

  17. Moss D, Urschitz MS, von Bodman A, Eitner S, Noehren A, Urschitz-Duprat PM, Schlaud M, Poets CF (2005) Reference values for nocturnal home polysomnography in primary schoolchildren. Pediatr Res 58:958–965

    Article  PubMed  Google Scholar 

  18. Iber C, Ancoli-Israel S, Chesson A, Quan SF, for the American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated event: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  19. American Academy of Sleep Medicine (2006) International classification of sleep disorders, 2nd edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  20. Urschitz MS, Wolff J, Von Einem V, Urschitz-Duprat PM, Schlaud M, Poets CF (2003) Reference values for nocturnal home pulse oximetry during sleep in primary school children. Chest 123:96–101

    Article  PubMed  Google Scholar 

  21. Uliel S, Tauman R, Greenfeld M, Sivan Y (2004) Normal polysomnographic respiratory values in children and adolescents. Chest 125:872–878

    Article  PubMed  Google Scholar 

  22. Verhulst SL, Schrauwen N, Haentjens D, Van Gaal L, De Backer WA, Desager KN (2007) Reference values for sleep-related respiratory variables in asymptomatic European children and adolescents. Pediatr Pulmonol 42:159–167

    Article  PubMed  CAS  Google Scholar 

  23. Urschitz MS, Brockmann PE, Schlaud M, Poets CF (2010) Population prevalence of obstructive sleep apnoea in a community of German third graders. Eur Respir J 36:556–568

    Article  PubMed  CAS  Google Scholar 

  24. Dohoo IR, Martin W, Stryhn H (2003) Veterinary epidemiologic research. AVC Inc., Charlottetown

    Google Scholar 

  25. Rosen CL, Storfer-Isser A, Taylor HG, Kirchner HL, Emancipator JL, Redline S (2004) Increased behavioral morbidity in school-aged children with sleep-disordered breathing. Pediatrics 114:1640–1648

    Article  PubMed  Google Scholar 

  26. Beebe DW, Wells CT, Jeffries J, Chini B, Kalra M, Amin R (2004) Neuropsychological effects of pediatric obstructive sleep apnea. J Int Neuropsychol Soc 10:962–975

    Article  PubMed  Google Scholar 

  27. Ali NJ, Pitson D, Stradling JR (1996) Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr 155:56–62

    PubMed  CAS  Google Scholar 

  28. Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, Marcus CL, Guire KE (2006) Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics 117:e769–e778

    Article  PubMed  Google Scholar 

  29. Blunden SL, Beebe DW (2006) The contribution of intermittent hypoxia, sleep debt and sleep disruption to daytime performance deficits in children: consideration of respiratory and non-respiratory sleep disorders. Sleep Med Rev 10:109–118

    Article  PubMed  Google Scholar 

  30. O'Brien LM, Holbrook CR, Mervis CB, Klaus CJ, Bruner JL, Raffield TJ, Rutherford J, Mehl RC, Wang M, Tuell A, Hume BC, Gozal D (2003) Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 111:554–563

    Article  PubMed  Google Scholar 

  31. Tauman R, O'Brien LM, Holbrook CR, Gozal D (2004) Sleep pressure score: a new index of sleep disruption in snoring children. Sleep 27:274–278

    PubMed  Google Scholar 

  32. Lopes MC, Guilleminault C (2006) Chronic snoring and sleep in children: a demonstration of sleep disruption. Pediatrics 118:e741–e746

    Article  PubMed  Google Scholar 

  33. Tauman R, O'Brien LM, Mast BT, Holbrook CR, Gozal D (2004) Peripheral arterial tonometry events and electroencephalographic arousals in children. Sleep 27:502–506

    PubMed  Google Scholar 

  34. Brockmann PE, Urschitz MS, Noehren A, Sokollik C, Schlaud M, Poets CF (2011) Risk factors and consequences of excessive autonomic activation during sleep in children. Sleep Breath. doi:10.1007/s11325-010-0349-0. published online 18 April 2010

  35. Aljadeff G, Gozal D, Schechtman VL, Burrell B, Harper RM, Ward SL (1997) Heart rate variability in children with obstructive sleep apnea. Sleep 20:151–157

    PubMed  CAS  Google Scholar 

  36. Brietzke SE, Katz ES, Roberson DW (2007) Pulse transit time as a screening test for pediatric sleep-related breathing disorders. Arch Otolaryngol Head Neck Surg 133:980–984

    Article  PubMed  Google Scholar 

  37. Katz ES, Lutz J, Black C, Marcus CL (2003) Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res 53:580–588

    Article  PubMed  Google Scholar 

  38. Rizzoli A, Urschitz MS, Sautermeister J, Miano S, Pagani J, Villa MP, Poets CF (2009) Pulse transit time for scoring subcortical arousal in infants with obstructive sleep apnea. Sleep Breath 13:137–146

    Article  PubMed  Google Scholar 

  39. Chervin RD, Clarke DF, Huffman JL, Szymanski E, Ruzicka DL, Miller V, Nettles AL, Sowers MR, Giordani BJ (2003) School performance, race, and other correlates of sleep-disordered breathing in children. Sleep Med 4:21–27

    Article  PubMed  Google Scholar 

  40. Kuehni CE, Strippoli MP, Chauliac ES, Silverman M (2008) Snoring in preschool children: prevalence, severity and risk factors. Eur Respir J 31:326–333

    Article  PubMed  CAS  Google Scholar 

  41. Jacob SV, Morielli A, Mograss MA, Ducharme FM, Schloss MD, Brouillette RT (1995) Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy. Pediatr Pulmonol 20:241–252

    Article  PubMed  CAS  Google Scholar 

  42. Alonso Alvarez ML, Teran Santos J, Cordero Guevara JA, Navazo Eguia AI, Ordax Carbajo E, Masa Jimenez JF, Pelayo R (2008) Reliability of respiratory polygraphy for the diagnosis of sleep apnea–hypopnea syndrome in children. Arch Bronconeumol 44:318–323

    Article  PubMed  Google Scholar 

  43. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P (1993) A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest 104:781–787

    Article  PubMed  CAS  Google Scholar 

  44. Bonnet M, Carley DW, Carskadon MA, Easton P, Guilleminault C, Harper R, Hayes B, Hirshkowitz M, Ktonas PY, Keenan S, Pressman M, Roehrs T, Smith J, Walsh JK, Weber S, Westbrook PR (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–84

    Google Scholar 

  45. Trang H, Leske V, Gaultier C (2002) Use of nasal cannula for detecting sleep apneas and hypopneas in infants and children. Am J Respir Crit Care Med 166:464–468

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Working Group on Paediatric Sleep Medicine, Department of Neonatology, University Children’s Hospital, University of Tuebingen, Tuebingen, Germany

    Pablo E. Brockmann, Michael S. Urschitz & Christian F. Poets

  2. Department of Paediatrics, Universidad Catolica de Chile, Santiago, Chile

    Pablo E. Brockmann

  3. Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany

    Martin Schlaud

  4. Working Group on Paediatric Sleep Medicine, Department of Neonatology, University Children’s Hospital, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany

    Michael S. Urschitz

Authors
  1. Pablo E. Brockmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael S. Urschitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Schlaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian F. Poets
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael S. Urschitz.

Additional information

P. Brockmann and M. Urschitz contributed equally to this publication.

The study was supported by a research grant from the Hans Meineke Foundation, Hannover, Germany.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brockmann, P.E., Urschitz, M.S., Schlaud, M. et al. Primary snoring in school children: prevalence and neurocognitive impairments. Sleep Breath 16, 23–29 (2012). https://doi.org/10.1007/s11325-011-0480-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-011-0480-6

Keywords

Search

Navigation