Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study

Abstract

Objective To determine the prevalence and risk factors of obstructive sleep apnoea syndrome (OSAS) in Chinese children using a two-phase community-based study design. Methods Children from 13 primary schools were randomly recruited. A validated OSAS screening questionnaire was completed by their parents. Children at high risk of OSAS and a randomly chosen low-risk group were invited to undergo overnight polysomnographic study and clinical examination. The the sex-specific prevalence rate was measured using different cutoffs (obstructive apnoea hypopnoea index $1, $1.5, $3 and $5 and obstructive apnoea index $5) and risk factors associated with OSAS were evaluated with logistic regression. Results 6447 completed questionnaires were returned (out of 9172 questionnaires; 70.3%). 586 children (9.1%; 405 boys and 181 girls) children belonged to the highrisk group. A total of 619 (410 and 209 from the high and low-risk group, respectively) subjects underwent overnight polysomnagraphy. Depending on the cutoffs, the prevalence rate of childhood OSAS varied from 4.8% to 40.3%. Using the International Criteria of Sleep Disorders version II, the OSAS prevalence for boys and girls was 5.8% and 3.8%, respectively. Male gender, body mass index z-score and increased adenoid and tonsil size were independently associated with OSAS. Conclusions The prevalence rate of OSAS in children was contingent on the cutoff used. The inclusion of symptoms as a part of the diagnostic criteria greatly reduced the prevalence. A further prospective and outcome study is needed to define a clinically significant diagnostic cutoff for childhood OSAS.Childhood obstructive sleep apnoea syndrome (OSAS) is a sleep-related breathing disorder characterised by intermittent upper airway obstruction that disrupts normal ventilation and sleep patterns. Increasing evidence suggests that childhood OSAS is an important public health problem. Children with OSAS have higher respiratory disease-related morbidity and healthcare utilisation starting from the first year of life until the date of diagnosis.2 If left untreated, the condition is associated with cardiovascular and neurocognitive consequences with significant long-term clinical implications. The reported prevalence of childhood OSAS varied from 0.1% to 13%. 9 The wide range of prevalence rate was mostly related to methodological issues, including lack of polysomnographic confirmation, different sampling strategies, small sample size and the different diagnostic threshold used for defining childhood OSAS. In addition, there is a suggestion of ethnic difference in the prevalence of OSAS, with African-American children having a higher prevalence compared with white children in the USA.10 11 In a recent review, the authors commented that additional work in childhood OSAS epidemiology is needed and standardisation of selection and diagnostic criteria across studies would be helpful in future crossethnic comparisons. 9 The ascertainment of a reliable and accurate prevalence of childhood OSAS will allow ...

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