TY - JOUR
T1 - Snoring, mouth-breathing, and apnea trajectories in a population-based cohort followed from infancy to 81 months
T2 - A cluster analysis
AU - Freeman, Katherine
AU - Bonuck, Karen
N1 - Funding Information:
This project was supported with a grant from the National Heart Lung and Blood Institute ( R21HL091241 ) to Dr. Bonuck.
Funding Information:
We are extremely grateful to all families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and lab technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The UK Medical Research Council (Grant # 74882 ) and the Wellcome Trust ( 076467 ) and the University for Bristol provide core support for ALSPAC.
PY - 2012/1
Y1 - 2012/1
N2 - Objective: The objective of this study was to characterize phenotypes of sleep disordered breathing (SDB) in early childhood that clinicians may find useful while monitoring symptom progression and associated SDB morbidity. Methods: We performed a cluster analysis of SDB's primary symptoms: snoring, mouth-breathing, and apnea. Parents in the Avon Longitudinal Study of Parents and Children (ALSPAC) reported SDB symptoms by questionnaire for their child at 6, 18, 30, 42, 57, 69, and 81 months of age. Participants were those from the original cohort exclusive of children with congental or other medical conditions predisposing growth aberrations or respiratory problems (i.e. cleft palate, heart surgery and associated conditions, genetic syndromes-primarily Down's, cancer or kidney conditions, celiac disease, congenital adrenal hyperplasia), missing SDB measures for ≥2 timepoints, or missing birth length plus 2 subsequent height measures. Results: Five clusters emerged from 10,441 children and were characterized according to patterns of mean severity of SDB symptoms over time. " Normals" (50%) were asymptomatic throughout. The " late snores and mouth-breathing" cluster (20%) remained asymptomatic until 4 years old. The " early snores" (10%) and " early apnea" (10%) clusters had peak symptoms at 6 and 18 months, respectively. In " all SDB after infancy" (10%), symptoms peaked from 30 to 42 months and remained elevated. Exploratory analyses found that " early snores" were significantly shorter than " normals." Associations with tonsillectomies and wheezing frequency supported external validation. Conclusions: Cluster analysis has elucidated the dynamic multi-symptom expression of SDB. The utility of cluster analysis will be evaluated in future analyses to predict growth, cognition and behavior outcomes.
AB - Objective: The objective of this study was to characterize phenotypes of sleep disordered breathing (SDB) in early childhood that clinicians may find useful while monitoring symptom progression and associated SDB morbidity. Methods: We performed a cluster analysis of SDB's primary symptoms: snoring, mouth-breathing, and apnea. Parents in the Avon Longitudinal Study of Parents and Children (ALSPAC) reported SDB symptoms by questionnaire for their child at 6, 18, 30, 42, 57, 69, and 81 months of age. Participants were those from the original cohort exclusive of children with congental or other medical conditions predisposing growth aberrations or respiratory problems (i.e. cleft palate, heart surgery and associated conditions, genetic syndromes-primarily Down's, cancer or kidney conditions, celiac disease, congenital adrenal hyperplasia), missing SDB measures for ≥2 timepoints, or missing birth length plus 2 subsequent height measures. Results: Five clusters emerged from 10,441 children and were characterized according to patterns of mean severity of SDB symptoms over time. " Normals" (50%) were asymptomatic throughout. The " late snores and mouth-breathing" cluster (20%) remained asymptomatic until 4 years old. The " early snores" (10%) and " early apnea" (10%) clusters had peak symptoms at 6 and 18 months, respectively. In " all SDB after infancy" (10%), symptoms peaked from 30 to 42 months and remained elevated. Exploratory analyses found that " early snores" were significantly shorter than " normals." Associations with tonsillectomies and wheezing frequency supported external validation. Conclusions: Cluster analysis has elucidated the dynamic multi-symptom expression of SDB. The utility of cluster analysis will be evaluated in future analyses to predict growth, cognition and behavior outcomes.
KW - Apnea
KW - Cluster analysis
KW - Epidemiology
KW - Mouth-breathing
KW - Pediatric
KW - Sleep disordered breathing
KW - Snoring
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U2 - 10.1016/j.ijporl.2011.10.019
DO - 10.1016/j.ijporl.2011.10.019
M3 - Article
C2 - 22093741
AN - SCOPUS:84855563659
SN - 0165-5876
VL - 76
SP - 122
EP - 130
JO - International journal of pediatric otorhinolaryngology
JF - International journal of pediatric otorhinolaryngology
IS - 1
ER -