Löfstrand-Tideström Britta, Hultcrantz Elisabeth
University of Linkoping, 581 85 Linkoping, Sweden.
Int J Pediatr Otorhinolaryngol. 2007 Jul;71(7):1025-33. doi: 10.1016/j.ijporl.2007.03.005. Epub 2007 May 4.
Snoring is common among both children and adults and a sign of sleep disordered breathing (SDB). Adenotonsillectomy is often the solution offered, although the effect is uncertain. There are also some who say that young children who snore will outgrow it even without treatment. The present investigation compares snoring and co-founding symptoms in parental reports for a cohort of children at age 4 and at age 6 years.
A cohort of 4 year old chidren (615) was investigated with respect to SDB [B. Löfstrand-Tideström, B. Thilander, J. Ahlqvist-Rastad, O. Jakobsson, E. Hultcrantz, Breathing obstruction in relation to craniofacial and dental arch morphology in 4 year old children, Eur. J. Orthod. 21 (1999) 323-332]. Each child was given a questionnaire. Those reporting significant symptoms also received a clinical and an orthodontic examination. Forty-eight children were diagnosed with SDB; of these 28 were operated with adenoidectomy and/or tonsillectomy. After 2 years, the same questionnaire was administered and the same children as before were further examined as well as those newly reporting significant symptoms. The results from the two occasions were compared.
Eighty-three percent (509) of the original cohort participated. The frequency of snoring had changed from 53 to 46% for the group as a whole (p<0.05). Significant gender differences in co-founding symptoms were seen. Severity of snoring had changed on an individual basis in half of the cases; some recovered, others got worse. Of the children with SDB at 4 years who were operated, 14/28, did not snore at all, compared to 3/18 of the non-operated (p<0.05).
Children who snore at the age 4 seldom "grow out of it" by age 6 and still show other signs of sleep related distress as well. Surgery does not always cure the snoring, thus postoperative follow-up is important. Since new cases develop during this age period, early intervention is not enough.
打鼾在儿童和成人中都很常见，是睡眠呼吸紊乱（SDB）的一种表现。腺样体扁桃体切除术通常是提供的解决方案，尽管效果不确定。也有一些人说，打鼾的幼儿即使未经治疗也会自行不再打鼾。本研究比较了一组4岁和6岁儿童的父母报告中的打鼾情况和并发症状。
对一组4岁儿童（615名）进行了睡眠呼吸紊乱方面的调查[B. Löfstrand-Tideström，B. Thilander，J. Ahlqvist-Rastad，O. Jakobsson，E. Hultcrantz，4岁儿童呼吸阻塞与颅面和牙弓形态的关系，欧洲正畸学杂志，21（1999）323 - 332]。给每个孩子发放了一份问卷。那些报告有明显症状的孩子还接受了临床和正畸检查。48名儿童被诊断为睡眠呼吸紊乱；其中28名接受了腺样体切除术和/或扁桃体切除术。2年后，发放相同的问卷，对之前相同的孩子以及新报告有明显症状的孩子进行了进一步检查。比较了两次的结果。
原队列中有83%（509名）参与。整个组的打鼾频率从53%变为46%（p<0.05）。在并发症状方面观察到显著的性别差异。一半的病例中打鼾严重程度在个体层面上发生了变化；一些人恢复了，另一些人则加重了。4岁时接受手术的睡眠呼吸紊乱儿童中，14/28完全不打鼾，相比之下，未手术的儿童中这一比例为3/18（p<0.05）。
4岁时打鼾的儿童到6岁时很少能“自行不再打鼾”，并且仍然表现出其他与睡眠相关的困扰迹象。手术并不总是能治愈打鼾，因此术后随访很重要。由于在这个年龄段会出现新的病例，早期干预是不够的。
