Frequency of Parent-reported Indicators of Sleep Disordered Breathing in Children with Clinical Diagnosis of Adenotonsillar Hypertrophy in Benin City, Nigeria

Abstract

Background: Sleep disordered breathing (SDB) comprises a wide spectrum of sleep-associated breathing abnormalities; those related to increase upper airway resistance include snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS). This concept suggests that a person who snores may be exhibiting the first manifestation of SDB and that snoring should not be viewed as normal. Obstructive sleep disordered breathing is common in children. Snoring, mouth breathing, and obstructive sleep apnea (OSA) often prompt parents to seek medical attention. Aim: This study aims to determine the frequency of parent-reported indicators of SDB among children clinically diagnosed with adenotonsilar hypertrophy (ATH) in the Otorhinolaryngology department of the University of Benin Teaching Hospital (UBTH), Benin City. Methods: This was a cross-sectional study of children aged 12 years and below who were sent to the Ear Nose and Throat clinics of UBTH, Benin-city with symptoms of obstructive adenotonsilar hypertrophy (ATH) between May 2012 and April 2014. All consecutive parent/caregiver who presented their child/ward to the ENT clinic with symptoms of obstructive adenotonsilar hypertrophy (ATH) were interviewed using structured questionnaire/proforma after verbal consent was obtained. Results:  A total of 104 children were studied. The children were 73 males and 31 females with a male/ female ratio of 2.4:1. The children were aged 1-12yrs with average age of 4.98 ± 2.68 years. The parents/caregivers were 92 females and 12 males giving a ratio of 7.6:1.The frequency of sleep apnea was reported by 50 children/care givers (48.1%). There was a high prevalence of reporting for patients between the ages of 1 and 4years 62 (59.6%) which was followed by those between 5 and 9 years 34 (32.7%). Symptoms lasted more than 3 years in 43(41.3%), 1-2 years in 31(29.9%) and less than 1 year in 30 (28.8%) of the patients. Symptoms reported were snoring 104 (100%), nasal obstruction 97(93%), nasal discharge 96 (92%), mouth breathing 92 (88%), sleep apnea 50 (48.1%), restless night sleep 72 (69.2%), sore throat 69(66.3%), failure to thrive 2(1.9%). Cervical (jugulo-digastric) lymph node was enlarged in 70 (67.3%). Tonsillar grades were as follows; grade 3 was 59 (56.7%), 4 was 27 (26%) while 1 and 2 accounted for 17 (16.3%). Conclusion: Snoring was the commonest symptom reported in children with SDB.  Parents and caregivers should monitor their children closely during sleep as this may reveal early symptoms of adenotonsilar hypertrophy causing SDB.