Chronic snoring and sleep in children: A demonstration of sleep disruption

OBJECTIVE. Chronic snoring that does not adhere to the criteria for a diagnosis of obstructive sleep apnea syndrome may be associated with learning and behavioral problems. We investigated the sleep structure of chronic snorers who had an apnea-hypopnea index of < 1 event per hour and analyzed the cyclic alternating pattern. METHODS. Fifteen successively seen chronic snorers (9.8 +/- 4 years) with an apnea-hypopnea index of < 1 and 15 aged-matched control subjects (10.3 +/- 5 years) underwent an investigation of their sleep with the determination of non-apneic-hypopneic breathing abnormalities polysomnographic scoring using current criteria and analysis of the cyclic alternating pattern. RESULTS. Chronic snorers have evidence of flow limitations and tachypnea during sleep even if they do not present with apneas, hypopneas, and decrease in oxygen saturations. They also present with abnormal cyclic alternating pattern rates and changes in phase A of cyclic alternating pattern compared with control subjects. CONCLUSIONS. An apnea-hypopnea index value cannot be the sole determinant in evaluating sleep-disordered breathing in children. Children who have chronic snoring and do not respond to the criteria for obstructive sleep apnea syndrome can present with an abnormal sleep electroencephalogram as evidenced by a significant increase in cyclic alternating pattern rates, with a predominance of abnormalities in slow wave sleep.