Clinical, radiological and polysomnographic evaluation of sleep disordered breathing in children

There is very little data of Indian children with sleep disordered breathing (SDB), regarding the common clinical presentation, etiological factors, radiological and polysomnographic features. We therefore carried out a study to evaluate these factors in Indian children presenting to a tertiary care hospital.

Forty consecutive children were referred from the ENT outpatient for overnight polysomnography because of symptoms suggestive of sleep disordered breathing (SDB). A complete general, physical and systemic examination, including height, weight, BMI, was conducted. ENT examination was performed to include craniofacial characteristics such as mid face hypoplasia, micrognathia and occlusal relationships. Radiological examination of the airway was performed. Digital skiagram of soft tissue neck in lateral view was obtained and A–N ratio (adenoid: nasopharynx ratio), H-MP (H-MP = distance from mandible to hyoid) and PAS (PAS = Posterior airway space) were assessed.

The age of the children varied from 1 to 15 years. A male preponderance was noticed (72.5%). Maximum number of the children was underweight (82.5%). All the children complained of snoring and mouth breathing. The other symptoms noted were disturbed sleep (65%); frequent cold and difficult swallowing (62.5%). Poor school performance was seen in 30%; Enuresis in 22.5% and aggressive behaviour in 7.5%. Analysis of the behavioural symptoms showed that 30% of the children had poor school performance, 22.5% had bedwetting, 7.5% had aggressive behaviour, 2.5% each had sleep terror and sleep walking respectively. The upper airway examination (clinical and endoscopic) showed that adenotonsillar enlargement was the most common cause of upper airway obstruction among these children. The other findings were adenoid enlargement (7.5%), tonsil enlargement (22.5%), deviated nasal septum (2.5%), deviated nasal septum with adenoid (2.5%), polyp (7.5%) and rhinitis (2.5%). Cephalometric analysis showed that The S-PAS value in controls was 15–20 mm whereas that of the cases was only 2–5mm. The distance from mandible to hyoid (H-MP) value was also found to be increased, thus indicating a low position of the mandible in 67.5% of cases. A:N ratio (A N ratio = adenoid: nasopharynx) was abnormal in 65% of the children. Polysomnography showed that 60% children had severe SDB (RDI>10 per hour) and 30% of them had moderately severe SDB (RDI 5–10/hr). About 50% children showed significant oxygen desaturation.

In conclusion it can be said that every child who snores is a suspected case of SDB. So there should be proper evaluation and management at the earliest to prevent potentially serious complications.