Natural history of sleep disordered breathing in prepubertal children transitioning to adolescence

Because there is a lack of agreed upon diagnostic criteria, it is critical to understand the natural history of obstructive sleep apnoea (OSA) in children in order to establish treatment strategies based on objective data. The Penn State Child Cohort is a representative, general-population sample of 700 elementary school children at baseline, of whom 421 were reassessed 8 years later, during adolescence. The remission of childhood apnoea-hypopnoea index (AHI) ≤2 events per h in adolescence was 52.9%. Using the higher threshold of AHI ≤5 events per h, remission was 100.0%, with 50.0% partially remitting to AHI 2-<5 events per h and the other half remitting to AHI <2 events per h. The incidence of adolescent AHI ≤2 events per h in those with childhood AHI <2 events per h was 36.5%, while the incidence of AHI ≤5 events per h in those with childhood AHI <5 events per h was 10.6%. This longitudinal study confirms that prepubertal OSA tends to resolve naturally during the transition to adolescence, and that primary snoring and mild sleep disordered breathing (SDB) do not appear to be strongly associated with progression to more severe SDB. The key risk factors for SDB in adolescence are similar to those found in middle-aged adults (i.e. male sex, older age and obesity). Moreover, consistent with recent studies in adults, this study includes the novel cross-sectional finding that visceral fat is associated with SDB as early as adolescence.