Pediatric obstructive sleep apnea (OSA) has become widely recognized only in the last few decades as a likely cause of significant morbidity among children. Many of the clinical characteristics of pediatric OSA, and the determinants of its epidemiology, differ from those of adult OSA. We systematically reviewed studies on the epidemiology of conditions considered part of a pediatric sleep-disordered breathing (SDB) continuum, ranging from primary snoring to OSA. We highlight a number of methodologic challenges, including widely variable methodologies for collection of questionnaire data about symptomatology, definitions of habitual snoring, criteria for advancing to further diagnostic testing, and objective diagnostic criteria for SDB or OSA. In the face of these limitations, estimated population prevalences are as follows: parent-reported “always” snoring, 1.5 to 6%; parent-reported apneic events during sleep, 0.2 to 4%; SDB by varying constellations of parent-reported symptoms on questionnaire, 4 to 11%; OSA diagnosed by varying criteria on diagnostic studies, 1 to 4%. Overall prevalence of parent-reported snoring by any definition in meta-analysis was 7.45% (95% confidence interval, 5.75–9.61). A reasonable preponderance of evidence now suggests that SDB is more common among boys than girls, and among children who are heavier than others, with emerging data to suggest a higher prevalence among African Americans. Less convincing data exist to prove differences in prevalence based on age. We conclude by outlining specific future research needs in the epidemiology of pediatric SDB.

/pdf/epidemiology-of-pediatric-obstructive-sleep-apnea-aypunpylsd.pdf

Epidemiology of pediatric obstructive sleep apnea

The aim of the present investigation was to perform a systematic review of the literature dealing with the issue of sleep bruxism prevalence in children at the general population level. Quality assessment of the reviewed papers was performed to identify flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. A total of 22 publications were included in the review, most of which had methodological problems limiting their external validity. Prevalence data extraction was performed only on eight papers that were consistent as for the sampling strategy and showed only minor external validity problems, but they had some common internal validity flaws related with the definition of sleep bruxism measures. All the selected papers based sleep bruxism diagnosis on proxy reports by the parents, and no epidemiological data were available from studies adopting other diagnostic strategies (e.g. polysomnography or electromyography). The reported prevalence was highly variable between the studies (3·5-40·6%), with a commonly described decrease with age and no gender differences. A very high variability in sleep bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism. This prevented from supporting any reliable estimates of the prevalence of sleep bruxism in children.

Prevalence of sleep bruxism in children: a systematic review of the literature.

Prevalence of malocclusion among mouth breathing children: do expectations meet reality?

This retrospective study investigated, in two cohorts of subjects living in Southern Italy and awaiting treatment for oral squamous cell carcinoma (OSCC), the variables related to diagnostic delay ascribable to the patient, with particular reference to the cognitive and psychological ones. A total of 156 patients with OSCC (mean age: 62 years, M/F: 2.39∶1) were recruited at the Universities of Palermo and Naples. Risk factors related to patient delay included: sociodemographic, health-related, cognitive and psychological variables. The analysis was conducted by considering two different delay ranges: dichotomous (≤1 month vs. >1 month) and polytomous ( 3 months) delay. Data were investigated by univariate and multivariate analyses and a P value ≤0.05 was considered statistically significant. For both delay measurements, the most relevant variables were: 'Personal experience of cancer' (dichotomous delay: P=0.05, odds ratio (OR)=0.33, 95% confidence interval (CI)=0.11-0.99; polytomous delay: P=0.006, Chi-square=10.224) and 'Unawareness' (dichotomous delay: P<0.01, OR=4.96, 95% CI=2.16-11.37; polytomous delay: P=0.087, Chi-square=4.77). Also 'Denial' (P<0.01, OR=6.84, 95% CI=2.31-20.24) and 'Knowledge of cancer' (P=0.079, Chi-square=8.359) were found to be statistically significant both for dichotomous and for polytomous categorization of delay, respectively. The findings of this study indicated that, in the investigated cohorts, the knowledge about cancer issues is strongly linked to the patient delay. Educational interventions on the Mediterranean population are necessary in order to increase the patient awareness and to emphasize his/her key role in early diagnosis of OSCC.

/pdf/diagnostic-delay-in-oral-squamous-cell-carcinoma-the-role-of-2pnsdahbcf.pdf

Diagnostic delay in oral squamous cell carcinoma: the role of cognitive and psychological variables.

AIM: This was to investigate the prevalence of sleep bruxism in Brazilian schoolchildren. METHODS: Across-sectional study was carried out examining 652 randomly selected children aged from 7 to 10 years of age from both public and private schools in Belo Horizonte, Brazil. Sleep bruxism among children was reported by parents by means of a pretested questionnaire based on the criteria of the American Academy of Sleep Disorders. The Social Vulnerability Index from Municipal database was used to determine social classification of families. A chi-square test was used with a significance level of 5%. RESULTS: Sleep bruxism was present in 230 children, showing a prevalence of 35.3%. Among the 652 children, 340 (52.0%) were girls and 312 (48.0%) were boys, predominatly of 8-year-olds (84.2%). Sleep bruxism was present in 56.5% of the girls and 43.5% of the boys. The majority of the families were of a low social vulnerability (54.2%), whereas another 45.8% were of a high social vulnerability. More than half of the children without sleep bruxism (55.2%) were of low socio-economic background. CONCLUSIONS: The high prevalence of 35.3% demonstrates the need for further research on this issue.

Prevalence of sleep bruxism in a group of Brazilian schoolchildren

Objective. This survey was conducted to examine the prevalence of sleep disorders in 2- to 12-year-old children in the Beijing area of China. Methods. From October 2001 to June 2002, 5979 children 2 to 12 years old in 6 randomly selected counties in Beijing were investigated with questionnaires. Results. The average total sleep time per day ranged from 11.38 hours among 2-year-olds down to 9.34 hours among 12-year-olds. The overall prevalence of sleep disorders was 21.2% and included parasomnia symptoms (bruxism [6.5%], sleep talking [4.9%], enuresis [1.0%], sleepwalking [0.6%], restless sleep [5.0%], and leg movements [1.9%]) and symptoms of sleep-disordered breathing (frequent snoring [5.6%], mouth breathing [4.1%], choking/gasping [0.9%], and breathing pauses [0.2%]). Conclusion. The overall prevalence of parent-reported symptoms of sleep disorders in a large sample of children in Beijing, China, was comparable to that reported in other countries, although the prevalence of some specific symptoms differed somewhat.

Brief report: An epidemiologic survey of the prevalence of sleep disorders among children 2 to 12 years old in Beijing, China.

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Brief report: An epidemiologic survey of the prevalence of sleep disorders among children 2 to 12 years old in Beijing, China.