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Acta Paediatr. 2013 Jan;102(1):e39-43. doi: 10.1111/apa.12033. Epub 2012 Nov 1.

Markers for severity of illness associated with decreased snoring in toddlers born ELGA.

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Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH 44106, USA.



To describe the prevalence of paediatric sleep disordered breathing (SDB) symptoms in extremely low gestational age infants and identify neonatal risk factors, including early exposure to hypoxia and hyperoxia.


Patients <28 weeks gestation were monitored with high-resolution pulse oximetry. Hypoxia/hyperoxia variables were defined as percentage time of first 4 weeks of life that SaO(2) < 80% or SaO(2) > 98%, respectively. Parents completed part of the OSA-18 questionnaire for symptoms of SDB at 18-22 months. Logistic regression was used to test the association between risk factors and sleep symptoms.


Of 182 patients recruited, 138 (76%) completed the questionnaire. The mean gestation was 26 weeks, and mean birth weight 887 grams. Loud snoring (21%) and restless sleep (24%) were the most prevalent symptoms. Female sex was associated with an increased risk of loud snoring (OR, 2.7; CI, 1.13-6.5). Prolonged mechanical ventilation, necrotizing enterocolitis and prolonged caffeine use, however, were inversely correlated with loud snoring. Neither neonatal hypoxia nor hyperoxia were associated with sleep symptoms.


While the prevalence of sleep disordered breathing symptoms is similar to reported rates, we found a sex difference not previously reported. Interestingly, markers for severity of illness show a pattern of being protective against loud snoring.

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