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Original Research: Sleep Disorders |

Natural History of Primary Snoring in School-aged ChildrenNatural History of Childhood Primary Snoring: A 4-Year Follow-up Study

Albert M. Li, MD; Yin Zhu, MM; Chun T. Au, MPhil; Dennis L. Y. Lee, MB; Crover Ho, RPSGT; Yun K. Wing, MB
Author and Funding Information

From the Department of Pediatrics (Dr Li, Ms Zhu, and Mr Au), the Department of Otorhinolaryngology - Head and Neck Surgery (Dr Lee), and the Department of Psychiatry (Mr Ho and Dr Wing), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

Correspondence to: Albert M. Li, MD, Department of Pediatrics, 6th Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong; e-mail: albertmli@cuhk.edu.hk


Drs Li and Zhu are the joint first authors of this manuscript.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This study was supported by a Direct Grant for Research from the Chinese University of Hong Kong [Ref. No. 2041773].


Chest. 2013;143(3):729-735. doi:10.1378/chest.12-1224
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Background:  The objective of this study was to examine the natural history of childhood primary snoring (PS) and to identify predictive clinical symptoms and risk factors associated with PS progression to obstructive sleep apnea (OSA).

Methods:  Children aged 6 to 13 years old who received a diagnosis of PS in our previous community-based OSA prevalence study were invited to undergo repeat polysomnography (PSG) at 4-year follow-up. Subjects with an obstructive apnea hypopnea index (OAHI) ≥ 1 were classified as having OSA at follow-up.

Results:  Seventy children (60% boys) with a mean age of 14.7 ± 1.8 years were analyzed in this follow-up study. The mean duration of follow-up was 4.6 ± 0.6 years. At follow-up, 26 subjects (37.1%) progressed to OSA, of whom five (7.1%) had moderate to severe disease (OAHI ≥ 5). Twenty-two (31.4%) remained at PS, and 18 (25.7%) had complete resolution of their snoring with normal PSG. Persistent snoring had a positive predictive value of 47.7% and a negative predictive value of 86.4% for progression from PS to OSA. Multivariate logistic regression analysis showed that persistent overweight/obesity was a significant risk factor for the development of OSA at follow-up, with an OR of 7.95 (95% CI, 1.43-44.09).

Conclusions:  More than one-third of school-aged children with PS progressed to OSA over a 4-year period, although only 7.1% developed moderate to severe disease. Weight control may be an important component in the management of PS because obesity was found to be a significant risk factor for PS progression.

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