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Original Research: SLEEP DISORDERS |

Sleep-Disordered Breathing Is a Risk Factor for Community-Acquired Alveolar Pneumonia in Early ChildhoodSleep-Disordered Breathing and Pneumonia

Aviv D. Goldbart, MD; Asher Tal, MD; Noga Givon-Lavi, PhD; Jacob Bar-Ziv, MD; Ron Dagan, MD; David Greenberg, MD
Author and Funding Information

From the Sleep-Wake Disorders Unit (Drs Goldbart and Tal), the Department of Pediatrics (Drs Goldbart and Tal), and the Pediatric Infectious Disease Unit (Drs Givon-Lavi, Dagan, and Greenberg), Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva; and the Department of Radiology (Dr Bar-Ziv), Hadassah University Medical Center, Jerusalem, Israel.

Correspondence to: Aviv D. Goldbart, MD, Department of Pediatrics, Sleep-Wake Disorders Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; e-mail: avivgold@bgu.ac.il


Funding/Support: This study was funded in part by Wyeth [Grant 0887X-101801 to R. D.] and by the Israel Science Foundation [Grant ISF 753/11 to A. D. G.].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1210-1215. doi:10.1378/chest.11-1998
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Background:  Data are scarce with regard to risk factors for acute community-acquired alveolar pneumonia (CAAP) in children, but it is known that children with sleep-disordered breathing (SDB) experience more respiratory infections. We aimed to assess whether SDB is a risk factor for CAAP in early childhood.

Methods:  We conducted a prospective, nested, case-control study assessing children < 5 years old who had been given a diagnosis of CAAP based on World Health Organization radiographic criteria. Demographic and clinical data were collected. SDB symptoms were documented using a structured questionnaire. CAAP study and retrospective sleep laboratory databases were compared. SDB presence and severity were determined by questionnaire and polysomnography (PSG).

Results:  A total of 14,913 children underwent chest radiography during the study period; 1,546 children with radiographically proven CAAP (58% boys) and 441 control subjects (54% boys) were prospectively enrolled. Frequent snoring was reported in 18.6% vs 2.9% subjects with CAAP and control subjects, respectively (P < .001). The respective figures for subjects with CAAP and control subjects for restless sleep, nocturnal breathing problems, abnormal behavior, and chronic rhinorrhea were 21.6% vs 5.3%, 5% vs 1.4%, 6.4% vs 0.2%, and 12.9% vs 1.8%, (P < .001 for each). Fifty children (3.3%) with CAAP vs three control subjects (0.7%) underwent adenoidectomy (P < .001). PSG diagnosis of obstructive sleep apnea had been established previously in 79 patients (5%) with CAAP vs six (1.3%) of the control subjects (OR, 3.7 [95% CI, 1.6-10.0]; P < .001), with higher severity in patients with CAAP than in control subjects.

Conclusions:  SDB is common in children with CAAP and is possibly a predisposing risk factor for CAAP in children < 5 years old. We recommend considering SDB in young children who are given a diagnosis of CAAP.

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