Aim and objective: Epidemiological studies of sleep disturbances are essential to promote awareness among families and educational officials and deliver appropriate treatment at a very early timing. The aim of this population-based study was to determine the frequency of sleep-disordered breathing (SDB) symptoms and its association with obesity among schoolchildren in West Saudi Arabia. Materials and methods: This cross-sectional study comprised 2,000 schoolchildren aged 6–12 years. Sleep-disordered breathing symptoms were assessed with Arabic version of Pediatric Sleep Questionnaire (PSQ). Overweight/obesity was evaluated using body mass index (BMI) and their association with SDB was tested using a regression analysis model. Results: Overall, 23% of children were at high risk of SDB. Prevalence of habitual snoring was 15.9% and sleep apnea 4%. Boys were at higher risk of SDB than girls (p = 0.026), while age had no effect (p = 0.254). High-risk SDB had a strong association with sleep symptoms compared to low-risk SDB (p < 0.05). Sleep-disordered breathing increased significantly in overweight and obese children (p = 0.017 and p < 0.001, respectively). Conclusion: Around 23% Saudi schoolchildren are at risk of SDB. Related symptoms were strongly associated with high risk of SDB. Overweight and obesity had a strong and progressive association with SDB. Clinical significance: The results will help in identifying children at high risk of developing SDB and plan for early intervention to avoid the progression of SDB later in life.
Ohida T, Osaki Y, Doi Y, et al. An epidemiologic study of self-reported sleep problems among Japanese adolescents. Sleep 2004;27(5): 978–985. DOI: 10.1093/sleep/27.5.978.
Alfano CA, Zakem AH, Costa NM, et al. Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depress Anxiety 2009;26(6):503–512.
Taras H, Potts-Datema W. Sleep and student performance at school. J Sch Health 2005;75(7):248–754. DOI: 10.1111/j.1746-1561.2005.tb06685.x.
Ayas NT, Owens RL, Kheirandish-Gozal L. Update in sleep medicine 2014. Am J Respir Crit Care Med 2015;92(4):415–420. DOI: 10.1164/rccm.201503-0647UP.
Jensen ME, Gibson PG, Collins CE, et al. Airway and systemic inflammation in obese children with asthma. Eur Respir J 2013;42(4):1012–1019. DOI: 10.1183/09031936.00124912.
Spruyt K, Molfese DL, Gozal D. Sleep duration, sleep regularity, body weight, and metabolic homeostasis in school-aged children. Pediatrics 2011;127(2):345–352. DOI: 10.1542/peds.2010-0497.
Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130(3):576–584. DOI: 10.1542/peds.2012-1671.
Jara SM, Benke JR, Lin SY, et al. The association between secondhand smoke and sleep-disordered breathing in children: a systematic review. Laryngoscope 2015;125(1):241–247. DOI: 10.1002/lary.24833.
Brockmann PE, Bertrand P, Castro-Rodriguez JA. Influence of asthma on sleep disordered breathing in children: a systematic review. Sleep Med Rev 2014;18(5):393–397. DOI: 10.1016/j.smrv.2014.01.005.
Beck SE, Marcus CL. Pediatric polysomnography. Sleep Med Clin 2009;4(3):393–406. DOI: 10.1016/j.jsmc.2009.04.007.
Traeger N, Schultz B, Pollock AN, et al. Polysomnographic values in children 2 to 9-years-old: additional data and review of the literature. Pediatr Pulmonol 2005;40(1):22–30. DOI: 10.1002/ppul.20236.
Corbo GM, Forastiere F, Agabiti N, et al. Snoring in 9- to 15-year-old children: risk factors and clinical relevance. Paediatrics 2001;108(5):1149–1154. DOI: 10.1542/peds.108.5.1149.
Ersu R, Arman AR, Save D, et al. Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in Istanbul. Chest J 2004;126(1):19–24. DOI: 10.1378/chest.126.1.19.
Rudnick EF, Walsh JS, Hampton MC, et al. Prevalence and ethnicity of sleep-disordered breathing and obesity in children. Otolaryngol Head Neck Surg 2007;137(6):878–882. DOI: 10.1016/j.otohns.2007. 08.002.
Redline S, Tishler PV, Schluchter M, et al. Risk factors for sleep-disordered breathing in children. associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 1999;159(5 Pt 1):1527–1532. DOI: 10.1164/ajrccm.159.5.9809079.
Li KK, Kushida C, Powell NB, et al. Obstructive sleep apnea syndrome: a comparison between far-east asian and white men. Laryngoscope 2000;110(10 Pt 1):1689–1693. DOI: 10.1097/00005537-200010000-00022.
Al-Hussaini A, Bashir MS, Khormi M, et al. Overweight and obesity among saudi children and adolescents: where do we stand today? Saudi J Gastroenterol 2019;25(4):229–235. DOI: 10.4103/sjg.SJG_617_18.
World Health Organization http://www.who.int/substance_abuse/research_tools/translation/en/. Accessed 21 Oct 2014.
CDC. About BMI for children and teens. Available at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmihtml.
Chervin RD, Hedger K, Dillon JE, et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 2000;1(1):21–32. DOI: 10.1016/S1389-9457(99)00009-X.
De Luca Canto G, Singh V, Major MP, et al. Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children: a systematic review and meta-analysis. J Am Dent Assoc 2014;145(2):165–178. DOI: 10.14219/jada.2013.26.
Reuveni H, Simon T, Tal A, et al. Health care services utilization in children with obstructive sleep apnea syndrome. Pediatrics 2002;110(1 Pt 1):68–72. DOI: 10.1542/peds.110.1.68.
BaHammam A, AlFaris E, Shaikh S, et al. Prevalence of sleep problems and habits in a sample of saudi primary school children. Ann Saudi Med 2006;26(1):7–13. DOI: 10.5144/0256-4947.2006.7.
Wang G, Xu G, Liu Z, et al. Sleep patterns and sleep disturbances among chinese school-aged children: prevalence and associated factors. Sleep Med 2013;14(1):45–52. DOI: 10.1016/j.sleep.2012. 09.022.
Kaditis AG, Finder J, Alexopoulos EI, et al. Sleep-disordered breathing in 3,680 greek children. Pediatr Pulmonol 2004;37(6):499–505. DOI: 10.1002/ppul.20002.
Schlaud M, Urschitz MS, Urschitz-Duprat PM, et al. The german study on sleep-disordered breathing in primary school children: epidemiological approach, representativeness of study sample, and preliminary screening results. Paediatr Perinat Epidemiol 2004;18(6):431–440. DOI: 10.1111/j.1365-3016.2004.00589.x.
Kuehni CE, Strippoli MP, Chauliac ES, et al. Snoring in preschool children: prevalence, severity and risk factors. Eur Respir J 2008;31(2):326–333. DOI: 10.1183/09031936.00088407.
Li AM, Au CT, So HK, et al. Prevalence and risk factors of habitual snoring in primary school children. Chest 2010;138(3):519–527. DOI: 10.1378/chest.09-1926.
Brunetti L, Rana S, Lospalluti ML, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1207 children of southern Italy. Chest J 2001;120(6):1930–1935. DOI: 10.1378/chest.120.6.1930.
Petry C, Pereira MU, Pitrez PM, et al. The prevalence of symptoms of sleep-disordered breathing in Brazilian schoolchildren. J Pediatr (Rio J) 2008;84(2):123–129. DOI: 10.1590/S0021-75572008000200006.
Gill AI, Schaughency E, Galland BC. Prevalence and factors associated with snoring in 3-year-olds: early links with behavioral adjustment. Sleep Med 2012;13(9):1191–1197. DOI: 10.1016/j.sleep.2012.05.007.
Ikävalko T, Närhi M, Eloranta AM, et al. Predictors of sleep disordered breathing in children: the PANIC study. Eur J Orthod 2018;40(3): 268–272. DOI: 10.1093/ejo/cjx056.
Kinkead R, Guertin PA, Gulemetova R. Sex, stress and their influence on respiratory regulation. Curr Pharm Des 2013;19(24):4471–4484. DOI: 10.2174/1381612811319240012. Review.
Basoglu OK, Tasbakan MS. Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients. Sleep Breath 2018;22(1):241–249. DOI: 10.1007/s11325-017-1482-9.
Verhulst S, Van Gaal L, De Backer W, et al. The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev 2008;12(5):339–346. DOI: 10.1016/j.smrv.2007.11.002.
Kohler MJ, van den Heuvel CJ. Is there a clear link between overweight/obesity and sleep disordered breathing in children? Sleep Med Rev 2008;12(5):347–361. DOI: 10.1016/j.smrv.2008.04.008.
Bugalho P, Mendonça M, Barbosa R, et al. The influence of sleep disordered breathing in REM sleep behavior disorder. Sleep Med 2017;37:210–215. DOI: 10.1016/j.sleep.2017.05.012.
Pahkala R, Seppä J, Ikonen A, et al. The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea. Sleep Breath 2014;18(2):275–282. DOI: 10.1007/s11325-013-0878-4.
Verhulst SL, Franckx H, Van Gaal L, et al. The effect of weight loss on sleep-disordered breathing in obese teenagers. Obesity (Silver Spring) 2009;17(6):1178–1183.
Siegfried W, Siegfried A, Rabenbauer M, et al. Snoring and sleep apnea in obese adolescents: effect of long-term weight loss-rehabilitation. Sleep Breath 1999;3(3):83–88. DOI: 10.1007/s11325-999-0083-7.
Kalra M, Inge T, Garcia V, et al. Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery. Obes Res 2005;13(7):1175–1179. DOI: 10.1038/oby.2005.139.
Sadeh A, Gruber R, Raviv A. Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Dev 2002;73(2): 405–417. DOI: 10.1111/1467-8624.00414.