The conundrum of primary snoring in children: what are we missing in regards to cognitive and behavioural morbidity?

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Abstract

Sleep disordered breathing (SDB) is common in children and describes a continuum of nocturnal respiratory disturbance from primary snoring (PS) to obstructive sleep apnoea (OSA). Historically, PS has been considered benign, however there is growing evidence that children with PS exhibit cognitive and behavioural deficits equivalent to children with OSA. There are two popular mechanistic theories linking SDB with daytime morbidity: hypoxic insult to the developing brain; and sleep disruption due to repeated arousals. These theories apply well to OSA, but children with PS experience neither hypoxia nor increased arousals when compared to non snoring controls. So what are we missing? This review summarises the literature examining daytime morbidity in children with PS and discusses the current debates surrounding this relationship. Specifically, questions exist as to the sensitivity of our standard assessment techniques to measure subtle hypoxia and arousal. There is also a suggestion that the association between PS and daytime morbidity may not be mediated by nocturnal respiratory disturbance at all, but by a number of other comorbid, but perhaps unrelated factors. As approximately 70 of children with SDB are diagnosed with PS, but are rarely treated, a paradigm shift in the investigation of PS may be required.
Original languageEnglish
Pages (from-to)463 - 475
Number of pages13
JournalSleep Medicine Reviews
Volume18
Issue number6
DOIs
Publication statusPublished - 2014

Cite this

@article{8549e019489442058da345d66b805e69,
title = "The conundrum of primary snoring in children: what are we missing in regards to cognitive and behavioural morbidity?",
abstract = "Sleep disordered breathing (SDB) is common in children and describes a continuum of nocturnal respiratory disturbance from primary snoring (PS) to obstructive sleep apnoea (OSA). Historically, PS has been considered benign, however there is growing evidence that children with PS exhibit cognitive and behavioural deficits equivalent to children with OSA. There are two popular mechanistic theories linking SDB with daytime morbidity: hypoxic insult to the developing brain; and sleep disruption due to repeated arousals. These theories apply well to OSA, but children with PS experience neither hypoxia nor increased arousals when compared to non snoring controls. So what are we missing? This review summarises the literature examining daytime morbidity in children with PS and discusses the current debates surrounding this relationship. Specifically, questions exist as to the sensitivity of our standard assessment techniques to measure subtle hypoxia and arousal. There is also a suggestion that the association between PS and daytime morbidity may not be mediated by nocturnal respiratory disturbance at all, but by a number of other comorbid, but perhaps unrelated factors. As approximately 70 of children with SDB are diagnosed with PS, but are rarely treated, a paradigm shift in the investigation of PS may be required.",
author = "Biggs, {Sarah Nichole} and Nixon, {Gillian Michelle} and Horne, {Rosemary Sylvia Claire}",
year = "2014",
doi = "10.1016/j.smrv.2014.06.009",
language = "English",
volume = "18",
pages = "463 -- 475",
journal = "Sleep Medicine Reviews",
issn = "1087-0792",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - The conundrum of primary snoring in children: what are we missing in regards to cognitive and behavioural morbidity?

AU - Biggs, Sarah Nichole

AU - Nixon, Gillian Michelle

AU - Horne, Rosemary Sylvia Claire

PY - 2014

Y1 - 2014

N2 - Sleep disordered breathing (SDB) is common in children and describes a continuum of nocturnal respiratory disturbance from primary snoring (PS) to obstructive sleep apnoea (OSA). Historically, PS has been considered benign, however there is growing evidence that children with PS exhibit cognitive and behavioural deficits equivalent to children with OSA. There are two popular mechanistic theories linking SDB with daytime morbidity: hypoxic insult to the developing brain; and sleep disruption due to repeated arousals. These theories apply well to OSA, but children with PS experience neither hypoxia nor increased arousals when compared to non snoring controls. So what are we missing? This review summarises the literature examining daytime morbidity in children with PS and discusses the current debates surrounding this relationship. Specifically, questions exist as to the sensitivity of our standard assessment techniques to measure subtle hypoxia and arousal. There is also a suggestion that the association between PS and daytime morbidity may not be mediated by nocturnal respiratory disturbance at all, but by a number of other comorbid, but perhaps unrelated factors. As approximately 70 of children with SDB are diagnosed with PS, but are rarely treated, a paradigm shift in the investigation of PS may be required.

AB - Sleep disordered breathing (SDB) is common in children and describes a continuum of nocturnal respiratory disturbance from primary snoring (PS) to obstructive sleep apnoea (OSA). Historically, PS has been considered benign, however there is growing evidence that children with PS exhibit cognitive and behavioural deficits equivalent to children with OSA. There are two popular mechanistic theories linking SDB with daytime morbidity: hypoxic insult to the developing brain; and sleep disruption due to repeated arousals. These theories apply well to OSA, but children with PS experience neither hypoxia nor increased arousals when compared to non snoring controls. So what are we missing? This review summarises the literature examining daytime morbidity in children with PS and discusses the current debates surrounding this relationship. Specifically, questions exist as to the sensitivity of our standard assessment techniques to measure subtle hypoxia and arousal. There is also a suggestion that the association between PS and daytime morbidity may not be mediated by nocturnal respiratory disturbance at all, but by a number of other comorbid, but perhaps unrelated factors. As approximately 70 of children with SDB are diagnosed with PS, but are rarely treated, a paradigm shift in the investigation of PS may be required.

UR - http://www.sciencedirect.com/science/article/pii/S1087079214000732

U2 - 10.1016/j.smrv.2014.06.009

DO - 10.1016/j.smrv.2014.06.009

M3 - Article

VL - 18

SP - 463

EP - 475

JO - Sleep Medicine Reviews

JF - Sleep Medicine Reviews

SN - 1087-0792

IS - 6

ER -