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This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents.The study was performed in a general population sample of 226 adolescents of both sexes (aged 11-19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred w1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared v1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy.There were 50 males and 40 females (mean¡SD age 13.5¡1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3¡1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages.These findings support the influence of sex hormones on sex differences in sleepdisordered breathing.

These data indicate normal sleep architecture in the adolescents. Although snorers as well as adolescents with some polysomnographic abnormality showed a higher number of respiratory arousals than control subjects, most obstructive events did not terminate with a cortical arousal, which may suggest that adolescents share with younger children this mechanism for preserving sleep architecture.

Summary.Upper airway obstruction causes many sleep-related respiratory disorders that can culminate in obstructive sleep apnea syndrome (OSAS). Polysomnography is routinely used to define OSAS in adults, but problems remain in diagnosing children by this method. The current study was designed to analyze the polysomnographic patterns in children with symptomatic adenotonsillar hypertrophy and to determine whether obstructive respiratory events shorter than 10 sec could have pathophysiological significance. Furthermore, we analyzed the correlation between clinical data on children with adenotonsillar hypertrophy and polysomnographic findings. Twelve children (mean age, 4.5 ? 1.5 years) with airflow obstruction due to adenotonsillar hypertrophy were observed in our Sleep Laboratory. Prior to study, a questionnaire was used to score symptom severity. Overnight polysomnography was then performed to measure total sleep time, sleep efficiency, desaturation index, minimal arterial oxygen saturation (SaO,), apneahypopnea (AH) episodes 2 5 sec and those 210 sec, and AH index, AH percentage of total test time, and number of spontaneous and respiratory event-associated desaturations were recorded. Respiratory events of 5 sec or longer resulted in increases in the AH index and an increase in the number of oxyhemoglobin desaturations due to respiratory events. A significant relationship was found between the AH index and AH episodes 25 sec and 2 1 0 sec. There was, however, no association between polysomnographic parameters and symptom severityscores. An appraisal of AH recordings 210 sec showed that desaturation episodes were more frequent than respiratory events, and the desaturation index was closely related to spontaneous and respiratory event-associated desaturations. When considering all obstructive episodes 25 sec, the number of desaturations did not exceed the number of respiratory events. The correlation between the desaturation index and spontaneous or respiratory event-associated desaturations was similar. The occurrence of short AH episodes that lead to hemoglobin desaturation are important in the evaluation of OSAS in children.

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