Parents of 996 children aged 4-5 years identified consecutively from the Oxford health visitor register were asked to complete a questionnaire about breathing disorders during sleep. A total of 782 (78.5%) was returned. Ninety five (12-1%) children were reported to snore on most nights. Habitual snoring was significantly associated with daytime sleepiness, restless sleep, and hyperactivity.The questionnaire responses were used to select two subgroups, one at high risk of a sleep and breathing disorder and a control group. These children (132 in total) were monitored at home with overnight video recording and oximetry, and had formal behavioural assessment using the Conners scale.Seven (7/66) children from the high risk group and none from the control group had obvious sleep disturbance consequent on snoring and upper airway obstruction. Thus our estimate of the prevalence of sleep and breathing disorders in this age group is 7/996 or 07%.The high risk group had significantly higher nocturnal movement, oxygen saturation dip rates, and overnight pulse rates than the controls. Maternal but not paternal smoking was associated with the high risk group. Parents and teachers thought those in the high risk group were more hyperactive and inattentive than the controls, but only their parents thought them more aggressive.Significant sleep and breathing disorders occur in about 07% of 4-5 year olds. Children whose parents report snoring and sleep disturbance have objective evidence of sleep disruption and show more behaviour problems than controls. This study has therefore addressed questions about the prevalence and psychological impact of undiagnosed sleep and breathing disorders in children: first, through a questionnaire survey about snoring and sleep problems in 996 randomly selected children aged 4 5-5 years; and second, by evaluating with home sleep studies and formalised behavioural assessments a high risk subgroup and comparing these children with a low risk control subgroup, with the two groups selected from the initial survey. Subjects QUESTIONNAIRE SURVEYNine hundred and ninety six boys and girls born consecutively between 8 January and 22 September 1985 and living in Oxford were identified from the centralised health visitor register. The ages at the time of study ranged from 4-5 to 5 * 5 years. SLEEP STUDY AND BEHAVIOURAL ASSESSMENT GROUPOn the basis of the answers to the initial questionnaire, two subgroups were selected for further study. Questions 1, 5, 6, 9, 10, and 11 (essentially about snoring and other symptoms of sleep and breathing disorders; see appendix) were given a weighting based on their ability to predict the presence of sleep and breathing disorders in a previous study from this department.7 The overall score was then used to rank the children in order of the likelihood of them having a sleep and breathing disorder. The 66 highest ranking children (henceforth the high risk group) and an equal number of sex matched children from the lowest rankings (henceforth the control group) were ...

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During obstructive sleep apnea, transient arousal at the resumption of breathing is coincident with a substantial rise in blood pressure. To assess the hemodynamic effect of arousal alone, 149 transient stimuli were administered to five normal subjects. Two electroencephalograms (EEG), an electrooculogram, a submental electromyogram (EMG), and beat-to-beat blood pressure (Finapres, Ohmeda) were recorded in all subjects. Stimulus length was varied to produce a range of cortical EEG arousals that were graded as follows: 0, no increase in high-frequency EEG or EMG; 1, increased high-frequency EEG and/or EMG for < 10 s; 2, increased high-frequency EEG and/or EMG for > 10 s. Overall, compared with control values, average systolic pressure rose [nonrapid-eye-movement (NREM) sleep 10.0 +/- 7.69 (SD) mmHg; rapid-eye-movement (REM) sleep 6.0 +/- 6.73 mmHg] and average diastolic pressure rose (NREM sleep 6.1 +/- 4.43 mmHg; REM sleep 3.7 +/- 3.02 mmHg) over the 10 s following the stimulus (NREM sleep, P < 0.0001; REM sleep, P < 0.002). During NREM sleep, there was a trend toward larger blood pressure rises at larger grades of arousal (systolic: r = 0.22, 95% confidence interval 0.02-0.40; diastolic: r = 0.48, 95% confidence interval 0.31-0.62). The average blood pressure rise in response to the grade 2 arousals was approximately 75% of that during obstructive sleep apnea. Arousal stimuli that did not cause EEG arousal still produced a blood pressure rise (mean systolic rise 8.6 +/- 7.0 mmHg, P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

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In 1989-90 a survey was carried out of the prevalence of snoring and related symptoms in 782 4 to 5 year old children.Two years later, in 1992, the same group of children was studied to gather information on the natural history of snoring and the related behaviour problems.A total of 507/782 (64-8%) completed questionnaires were received. Compari Trend analysis showed that the increasing prevalence of sleepiness, hyperactivity, and restless sleep across the snoring categories was highly significant. Daytime sleepiness, hyperactivity, and restless sleep were all significantly more common in the habitual snorers than in those who never snored. Relative risks (95%/o confidence interval) were as follows: daytime sleepiness 6-13 (2.5 to 14-9), hyperactivity 2-78 (1.6 to 4.7), and restless sleep 2*3 (1.6 to 3.2).Though habitual snoring and the associated behaviour problems resolved spontaneously over two years in about half of the children with these symptoms, there is still the same overall percentage with these problems due to the emergence of new cases. Osler Chest Unit,