Skip to main content
SpringerLink
Log in

Obstructive sleep apnea in Asian primary school children

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

Abstract

Purpose

The objectives of this study were to examine the prevalence of obstructive sleep apnea (OSA) in primary school children, relationships between OSA and tonsillar hypertrophy, adenoid, and patency of the nasal cavity, and the effects of the tonsillar hypertrophy and adenoid on the nasal patency.

Methods

An examination of the palatine tonsils and anterior rhinoscopy, completion of a questionnaire survey, a measurement of nasal resistance, an examination for sleep apnea at home using portable polysomnography device, and radiography of pharyngeal tonsil were performed in 152 primary school children.

Results

The obstructive apnea hypopnea index (O-AHI) increased with enlargements in the palatine tonsils. The adenoidal nasopharyngeal ratio (A/N ratio) decreased with advances in grade. A significant difference was observed in the O-AHI between those with and without adenoid. The median value of the O-AHI increased with advances in grade. The nasal resistance was significantly higher in the group with adenoid compared as in the group without. It was also higher in the nasal disease group with OSA than in the group without. Full polysomnography(PSG) was recommended in 16 (10.5 %) of 152 who underwent the examination using the portable polysomnography device, and of the eight who underwent PSG, six (75 %) were confirmed to have OSA, while its prevalence in all subjects was estimated as 7.9 %.

Conclusions

Disturbances in nasal respiration as well as tonsillar hypertrophy and adenoid were found to be a risk factor of OSA in primary school children.

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. Jeans WD, Fernando DC, Maw AR, Leighton BC (1981) A longitudinal study of the growth of the nasopharynx and its contents in normal children. Br J Radiol 54:117–121

    Article  CAS  PubMed  Google Scholar 

  2. Papaioannou G, Kambas I, Tsaoussoglou M, Panaghiotopoulou-Gartagani P, Chrousos G, Kaditis AG (2013) Age-dependent changes in the size of adenotonsillar tissue in childhood: implications for sleep-disordered breathing. J Pediatr 162:269–274

    Article  PubMed  Google Scholar 

  3. Konno A, Togawa K, Hoshino T (1980) The effect of nasal obstruction in infancy and early childhood upon ventilation. Laryngoscope 90:699–707

    CAS  PubMed  Google Scholar 

  4. American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  5. Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R, Paruthi S, Muzumdar H, Gozal D, Thomas NH, Ware J, Beebe D, Snyder K, Elden L, Sprecher RC, Willging P, Jones D, Bent JP, Hoban T, Chervin RD, Ellenberg SS, Redline S, Childhood Adenotonsillectomy Trial (CHAT) (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 368:2366–2376

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Ali NJ, Pitson DJ, Stradling JR (1993) Snoring, sleep disturbance, and behaviour in 4–5 year olds. Arch Dis Child 68:360–366

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Gislason T, Benediktsdóttir B (1995) Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest 107:963–966

    Article  CAS  PubMed  Google Scholar 

  8. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G (1999) Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 159:1527–1532

    Article  CAS  PubMed  Google Scholar 

  9. Unno T, Naitoh Y, Sakamoto N, Horikawa H (1986) Nasal resistance measured by anterior rhinomanometry. Rhinology 24:49–55

    CAS  PubMed  Google Scholar 

  10. Georgitis JW (1985) The applicability of rhinomanometry in nonatopic children: comparison of three techniques. J Allergy Clin Immunol 75:614–620

    Article  CAS  PubMed  Google Scholar 

  11. Brodsky L (1989) Modern assessment of tonsils and adenoids. Pediatr Clin N Am 36:1551–1569

    CAS  Google Scholar 

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

    Google Scholar 

  13. Fujioka M, Young LW, Girdany BR (1979) Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol 133:401–404

    Article  CAS  PubMed  Google Scholar 

  14. Nakayama M, Koike S, Kuriyama S, Suzuki M, Nakamura Y, Yamamoto K, Murakami S, Gozal D (2013) Seasonal variation in a clinical referral pediatric cohort at risk for obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 77:266–269

    Article  PubMed  Google Scholar 

  15. Gozal D, Shata A, Nakayama M, Spruyt K (2011) Seasonal variability of sleep-disordered breathing in children. Pediatr Pulmonol 46:581–586

    Article  PubMed  Google Scholar 

  16. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, Darrow DH, Giordano T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM (2011) American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 144:S1–S30

    Article  PubMed  Google Scholar 

  17. Kobayashi R, Miyazaki S, Karaki M, Kobayashi E, Karaki R, Akiyama K, Matsubara A, Mori N (2011) Measurement of nasal resistance by rhinomanometry in 892 Japanese elementary school children. Auris Nasus Larynx 38:73–76

    Article  PubMed  Google Scholar 

  18. Kobayashi R, Miyazaki S, Karaki M, Hara H, Kikuchi A, Kitamura T, Mori N (2012) Nasal resistance in Japanese elementary school children: determination of normal value. Acta Otolaryngol 132:197–202

    Article  PubMed  Google Scholar 

  19. Nakata S, Miyazaki S, Ohki M, Morinaga M, Noda A, Sugiura T, Sugiura M, Teranishi M, Katayama N, Nakashima T (2007) Reduced nasal resistance after simple tonsillectomy in patients with obstructive sleep apnea. Am J Rhinol 21:192–195

    Article  PubMed  Google Scholar 

  20. Joshua B, Bahar G, Sulkes J, Shpitzer T, Raveh E (2006) Adenoidectomy: long-term follow-up. Otolaryngol Head Neck Surg 135:576–580

    Article  PubMed  Google Scholar 

  21. Rizzi M, Onorato J, Andreoli A, Colombo S, Pecis M, Marchisio P, Morelli M, Principi N, Esposito S, Sergi M (2002) Nasal resistances are useful in identifying children with severe obstructive sleep apnea before polysomnography. Int J Pediatr Otorhinolaryngol 65:7–13

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Ms. Naomi Kubo, Ms. Miho Shirafuji, and Mr. Takayuki Shinota for their assistance with the rhinomanometry measurements and statistical analysis. We are also grateful to Ms. Ikuko Morita, who analyzed the portable monitor device data.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Author information

Authors and Affiliations

  1. Sleep Disordered Breathing Center, Ayagawa National Health Insurance Sue Hospital, 1720-1 Sue, Ayagawa-cho, Ayauta-gun, Kagawa, 761-2103, Japan

    Ryuichi Kobayashi

  2. Department of Otorhinolaryngology and Allergy, Ayagawa National Health Insurance Sue Hospital, Kagawa, Japan

    Ryuichi Kobayashi

  3. Department of Sleep Medicine, Shiga University of Medical Science, Shiga, Japan

    Soichiro Miyazaki

  4. Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Masayuki Karaki, Hiroshi Hoshikawa & Nozomu Mori

  5. Department of Otolaryngology, Fujita Health University Banbuntane Houtokukai Hospital, Aichi, Japan

    Seiichi Nakata

  6. Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan

    Hirotaka Hara

  7. Department of Otolaryngology, Kikuchi Clinic, Ehime, Japan

    Atsushi Kikuchi

  8. Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan

    Takuro Kitamura

Authors
  1. Ryuichi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soichiro Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masayuki Karaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Hoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seiichi Nakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hirotaka Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Atsushi Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takuro Kitamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nozomu Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryuichi Kobayashi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kobayashi, R., Miyazaki, S., Karaki, M. et al. Obstructive sleep apnea in Asian primary school children. Sleep Breath 18, 483–489 (2014). https://doi.org/10.1007/s11325-013-0909-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-013-0909-1

Keywords

Search

Navigation