Format

Send to

Choose Destination
Sleep Med. 2018 Aug;48:93-100. doi: 10.1016/j.sleep.2018.04.008. Epub 2018 May 3.

Phenotypes of sleep-disordered breathing symptoms to two years of age based on age of onset and duration of symptoms.

Author information

1
Department of Pediatrics, University of Alberta, Alberta, Canada.
2
Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
3
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Respiratory Medicine, Hospital for Sick Children, Canada.
4
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
5
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
6
Department of Educational Psychology, University of Alberta, Alberta, Canada.
7
Department of Pediatrics, University of Alberta, Alberta, Canada. Electronic address: mandhane@ualberta.ca.

Abstract

OBJECTIVE:

Childhood sleep-disordered breathing (SDB) symptoms may comprise multiple phenotypes depending on craniofacial anatomy, tonsil and adenoid growth, body habitus, and rhinitis symptoms. The primary objective of this study is to identify and characterize the different SDB phenotypes to two years of age.

METHODS:

Data from 770 infants in the Edmonton sub-cohort of the Canadian Healthy Infant Longitudinal Study (CHILD) were analyzed to identify SDB phenotypes based on age of onset and duration of symptoms. Parents completed the 22-item sleep-related breathing disorder (SRBD) scale. Children with a SRBD ratio greater than 0.33 were considered positive for SDB at each quarterly assessment between three months and two years. The STATA Proc trajectory extension identified SDB phenotypes based on their age of onset and duration of symptoms and attributed the percentage chance of a participant being assigned to each phenotype. Multivariate linear regression identified factors associated with increased risk of being assigned to each SDB phenotype.

RESULTS:

Trajectory analysis identified four phenotypes: no SDB (65.7%), early-onset SDB (15.7%) with peak symptoms at nine months, late-onset SDB (14.2%) with peak symptoms at 18 months, and persistent SDB (5.3%) with symptoms from 3 to 24 months. Rhinitis was associated with all three SDB symptom trajectories (p < 0.05). Children with gastroesophageal reflux disease presented with early (p = 0.03) and late SDB (p < 0.001). Maternal obstructive sleep apnea syndrome (OSAS) was associated with persistent (p = 0.01) and late SDB (p < 0.001). Atopy (positive skin prick test at one year) was associated with persistent SDB (p = 0.04). Infants born prior to 36.5 weeks gestational age were more likely to present with late SDB (p = 0.03).

CONCLUSION:

Childhood SDB symptoms, rather than being a homogenous disorder, may comprise multiple overlapping phenotypes each with unique risk factors.

KEYWORDS:

Birth cohort; Pediatric; Population-representative; Sleep-disordered breathing

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center