Chest
Original ResearchSleep DisordersSleep-Disordered Breathing Is a Risk Factor for Community-Acquired Alveolar Pneumonia in Early Childhood
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
References (25)
- et al.
Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity
J Pediatr
(2003) - et al.
Childhood obstructive sleep apnea: one or two distinct disease entities?
Sleep Med Clin
(2007) - et al.
Rates of hospitalization for respiratory syncytial virus infection among children in medicaid
J Pediatr
(2000) - et al.
Prenatal and neonatal risk factors for sleep disordered breathing in school-aged children born preterm
J Pediatr
(2008) - et al.
Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection
Chest
(2004) - et al.
Global estimate of the incidence of clinical pneumonia among children under five years of age
Bull World Health Organ
(2004) - et al.
Pneumonia
- et al.
The multiple challenges of obstructive sleep apnea in children: morbidity and treatment
Curr Opin Pediatr
(2008) - et al.
Health care services utilization in children with obstructive sleep apnea syndrome
Pediatrics
(2002) - et al.
Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome
Sleep
(2003)
Elevated morbidity and health care use in children with obstructive sleep apnea syndrome
Am J Respir Crit Care Med
Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies
Bull World Health Organ
Cited by (18)
Effects of Obstructive Sleep Apnea on Airway Immunity and Susceptibility to Respiratory Infections
2024, Sleep Medicine ClinicsSafety and long-term efficacy of tonsillectomy versus subtotal tonsillectomy in children with sleep disordered breathing
2022, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :parents were contacted by phone, and after granting oral consent to participate in the study, answered a 9-item questionnaire (Appendix), in their mother language (Hebrew or Arabic). This questionnaire, which was used in a previous study11, contained questions regarding symptoms of SDB as witnessed within 3–5 years post-surgery, the summary of which was a score representing the degree of SDB symptoms. Eight of nine questionnaire's items score was 1 when answered positively, and only the question regarding snoring was scored either 1 or 2 depending on the snoring frequency.
Restless sleep in children: A systematic review
2021, Sleep Medicine ReviewsCitation Excerpt :The majority of these studies were rated as “good” for the items “Study population, definition and selection”, “Soundness of information”, “Analysis, comparability and outcomes”, while the “fair” and “good” ratings were approximately similar for “Interpretation and reporting” (Table 2). Four studies assessed restless sleep in children with respiratory disorders (Table 4) [32–35], three in patients with asthma [36–38], and two in smoke exposed patients [39,40]. Pneumonia, upper respiratory tract infections with or without otitis media, tonsillitis, hypertrophy of tonsils, and coughing at night were all found to be associated with restless sleep, with variable prevalence ranging from 16.8% to 48.5%.
Obstructive Sleep Apnea Syndrome: Pathophysiology and Clinical Characteristics
2012, Principles and Practice of Pediatric Sleep Medicine: Second EditionSleep apnea and risk of pneumonia: A nationwide population-based study
2014, CMAJ. Canadian Medical Association JournalCitation Excerpt :Another study by Morimoto and coauthors10 showed that, among older inpatients with sleep apnea, mortality from all causes was increased as well as from pneumonia. A nested case–control study showed that, among children with sleep apnea, those with pneumonia had a higher rate of obstructive sleep apnea (79/1546, 5%) than those without pneumonia (6/441, 1.3%) (p < 0.001).9 In contrast to several studies that showed an association between sleep apnea and pneumonia, Sanner and associates11 found that patients with sleep apnea who received CPAP therapy (n = 206) had an increased risk of upper airway infections compared with patients who received conservative treatment (n = 40), whereas the risk of pneumonia was not significantly increased (only 1 pneumonia event on 3 years' follow-up v. 0 in controls).
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).