Chest
Volume 141, Issue 5, May 2012, Pages 1210-1215
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Original Research
Sleep Disorders
Sleep-Disordered Breathing Is a Risk Factor for Community-Acquired Alveolar Pneumonia in Early Childhood

https://doi.org/10.1378/chest.11-1998Get rights and content

Background

Data are scarce with regard to risk factors for acute community-acquired alveolar pneumonia (CAAP) in children, but it is known that children with sleep-disordered breathing (SDB) experience more respiratory infections. We aimed to assess whether SDB is a risk factor for CAAP in early childhood.

Methods

We conducted a prospective, nested, case-control study assessing children < 5 years old who had been given a diagnosis of CAAP based on World Health Organization radiographic criteria. Demographic and clinical data were collected. SDB symptoms were documented using a structured questionnaire. CAAP study and retrospective sleep laboratory databases were compared. SDB presence and severity were determined by questionnaire and polysomnography (PSG).

Results

A total of 14,913 children underwent chest radiography during the study period; 1,546 children with radiographically proven CAAP (58% boys) and 441 control subjects (54% boys) were prospectively enrolled. Frequent snoring was reported in 18.6% vs 2.9% subjects with CAAP and control subjects, respectively (P < .001). The respective figures for subjects with CAAP and control subjects for restless sleep, nocturnal breathing problems, abnormal behavior, and chronic rhinorrhea were 21.6% vs 5.3%, 5% vs 1.4%, 6.4% vs 0.2%, and 12.9% vs 1.8%, (P < .001 for each). Fifty children (3.3%) with CAAP vs three control subjects (0.7%) underwent adenoidectomy (P < .001). PSG diagnosis of obstructive sleep apnea had been established previously in 79 patients (5%) with CAAP vs six (1.3%) of the control subjects (OR, 3.7 [95% CI, 1.6-10.0]; P < .001), with higher severity in patients with CAAP than in control subjects.

Conclusions

SDB is common in children with CAAP and is possibly a predisposing risk factor for CAAP in children < 5 years old. We recommend considering SDB in young children who are given a diagnosis of CAAP.

Section snippets

Study Design and Setting

This prospective, population-based, case-control study was conducted from March 2006 through September 2008. The Soroka University Medical Center is the only hospital in southern Israel. The region had 520,000 inhabitants in 2006-2008. During the study period, children < 5 years old in the region accounted for 67,300 to 74,000 annually.10 Medical insurance for children in Israel is universal and is provided free of charge. There are no financial or other barriers to health-care service use in

Results

A total of 14,913 children underwent chest radiography during the study period. Radiographically proven community-acquired pneumonia was diagnosed in 2,558 (17.2%) episodes. Of these, alveolar pneumonia was diagnosed in 2,465 subjects (95.7%) and nonalveolar pneumonia in 93 (4.3%). The final study group included 2,465 children (58% males), and 441 control subjects (54% boys) were prospectively enrolled. Of those 2,465 eligible cases, 1,546 (62.7%) were eventually enrolled, because the rest were

Discussion

This study reveals that SDB serves as a risk factor for CAAP in young children. We now report that SDB is significantly more common and is clinically present at least 12 months prior to the infectious event. Furthermore, a direct correlation exists between the severity of SDB and the chances of receiving a diagnosis of pneumonia.

Childhood community-acquired infections are a frequent cause of physician visits, antibiotic and over-the-counter drug consumption, work loss, and reduction of quality

Conclusions

CAAP in children was found significantly more frequently in children with SDB than in control subjects. In addition, a linear association was found between the severity of SDB and the risk of CAAP. Thus, SDB is an independent risk factor predisposing for pneumonia in early childhood. We recommend that SDB presence be ruled out by detailed history and physical examination in young children who receive a diagnosis of CAAP, which may suggest the need to refer the patient to a specialist.

Acknowledgments

Author contributions: Dr Goldbart had full access to all the data in the study and takes responsibility for the integrity and accuracy of the data analysis.

Dr Goldbart: contributed to the study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; obtaining of funding; administrative, technical or material support; and supervision.

Dr Tal: contributed to the study concept

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    Funding/Support: This study was funded in part by Wyeth [Grant 0887X-101801 to R. D.] and by the Israel Science Foundation [Grant ISF 753/11 to A. D. G.].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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