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Snoring, mouth-breathing, and apnea trajectories in a population-based cohort followed from infancy to 81 months: a cluster analysis.
Int J Pediatr Otorhinolaryngol. 2012 Jan; 76(1):122-30.IJ

Abstract

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.

Authors+Show Affiliations

Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States. kfreeman@montefiore.orgNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

22093741

Citation

Freeman, Katherine, and Karen Bonuck. "Snoring, Mouth-breathing, and Apnea Trajectories in a Population-based Cohort Followed From Infancy to 81 Months: a Cluster Analysis." International Journal of Pediatric Otorhinolaryngology, vol. 76, no. 1, 2012, pp. 122-30.
Freeman K, Bonuck K. Snoring, mouth-breathing, and apnea trajectories in a population-based cohort followed from infancy to 81 months: a cluster analysis. Int J Pediatr Otorhinolaryngol. 2012;76(1):122-30.
Freeman, K., & Bonuck, K. (2012). Snoring, mouth-breathing, and apnea trajectories in a population-based cohort followed from infancy to 81 months: a cluster analysis. International Journal of Pediatric Otorhinolaryngology, 76(1), 122-30. https://doi.org/10.1016/j.ijporl.2011.10.019
Freeman K, Bonuck K. Snoring, Mouth-breathing, and Apnea Trajectories in a Population-based Cohort Followed From Infancy to 81 Months: a Cluster Analysis. Int J Pediatr Otorhinolaryngol. 2012;76(1):122-30. PubMed PMID: 22093741.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Snoring, mouth-breathing, and apnea trajectories in a population-based cohort followed from infancy to 81 months: a cluster analysis. AU - Freeman,Katherine, AU - Bonuck,Karen, Y1 - 2011/11/16/ PY - 2011/06/09/received PY - 2011/10/18/revised PY - 2011/10/22/accepted PY - 2011/11/19/entrez PY - 2011/11/19/pubmed PY - 2012/5/17/medline SP - 122 EP - 30 JF - International journal of pediatric otorhinolaryngology JO - Int J Pediatr Otorhinolaryngol VL - 76 IS - 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. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/22093741/Snoring_mouth_breathing_and_apnea_trajectories_in_a_population_based_cohort_followed_from_infancy_to_81_months:_a_cluster_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(11)00555-6 DB - PRIME DP - Unbound Medicine ER -