An Objective,Anatomically Based Analysis of Pediatric Snoring

Abstract

Objectives:

The implications and anatomical basis of pediatric snoring (PS) remain largely unknown. The objectives of this study are to: (1) Objectively assess PS using home sleep test (HST) technology. (2) Attempt to correlate the objective components of PS to upper airway anatomy. (3) Objectively measure the effects of adenotonsillectomy (±turbinoplasty) on PS.

Methods:

Pediatric patients with a chief complaint of snoring and probable obstructive sleep apnea underwent a HST (SNAP Diagnostics, USA) with a detailed acoustical analysis of snoring prior to adenotonsillectomy (±turbinoplasty). During surgery, detailed anatomical measurements were performed and correlated with snoring analysis results. After surgery, patients were offered another HST with snoring analysis. Data analysis was performed using descriptive statistics and statistical correlation with attention to the multiple comparisons paradox.

Results:

Twenty-two patients (45% male; mean age, 5.4 years; range, 2.4-8.4 years) completed the preoperative HST and intra-operative measurements. Unlike typical adult snoring, only the minority of PS was from palatal flutter (mean palatal component = 24%, median = 10%). The resistance occurrence percentage (ROP, % of breathing events with snoring noise) was associated with body mass index (BMI; Spearmans Rho = 0.55, P = .017), subjective turbinate size (0.54, P = .032), lowest oxygen saturation (–0.46, P = .043), and palatal obstruction (0.62, P = .008) but not adenotonsillar hypertrophy. Ten patients (45%) completed a postoperative HST. The ROP was significantly reduced (median 20.5% vs 6.5%, P = .006 Sign rank test) postoperatively. The magnitude of the ROP reduction was directly proportional to the measured volume of the removed tonsils (0.74, P = .022).

Conclusions:

Pediatric snoring has different acoustical characteristics than adult snoring. Objective PS is associated with BMI, turbinate size, and palatal position/obstruction. Adenotonsillectomy (±turbinoplasty) significantly reduces objective PS.