Prevalence of snoring and sleep-disordered breathing at school children in Balikesir city center

Objective: Sleep-disordered breathing is a common disease in school children and the most important symptom is snoring. As in the world, there are not enough studies on the prevalence of sleep-disordered breathing in children in our country. The frequency of snoring and sleep-disordered breathing in Balıkesir is not known. In this study, we aimed to investigate the frequency of snoring and sleep-disordered breathing in primary school children in Balıkesir city center and also to question the associated clinical findings by using a questionnaire with proven validity and reliability in Turkish. Materials and Methods: We conducted the single-centered, cross-sectional, prospective study between January 2022 and May 2022. Children between the ages of 5-13 in primary schools in Balıkesir city center formed the universe of the study. Preschool, 1st grade, 4th grade, 6th grade and 8th grade children were included in the study to apply the parent questionnaire. The sample size was determined as 750 when the frequency of sleep breathing disorder was accepted as 15%, the confidence interval as 95% and the standard error as 2.5%. 13 schools were determined from among the provincial central schools by simple random sampling method. After the necessary written permissions were obtained, 1300 questionnaires were distributed to the students in the selected classes by systematic sampling method. Stratified sampling and proportional selection were used because the preschool age group was in the minority. Data were collected with a questionnaire containing the Pediatric Sleep Questionnaire (PSQ) scale delivered to the parents. Snoring states, presence of sleep-disordered breathing and associated clinical findings were analyzed. Results: 856 (66%) children whose questionnaires were filled in accordance with the study criteria were included in our study. The frequency of habitual snoring in children aged 5-13 years in Balıkesir city center was 5.58%, and the frequency of sleep-disordered breathing was 9.11%. Frequency of snoring (M/F: 5.4/5.7%; p=0.86) and sleep-disordered breathing (M/F: 8.8%/9.4%; p=0.73) when compared by gender no significant difference was found. Although the frequency of habitual snoring was found to be high (7.3%) in the 5-6 age group when age groups were compared, it was not statistically significant (p=0.198). There was also no significant difference in the frequency of sleep-disordered breathing when compared with age (p= 0.50). Accompanying systemic disease was present in 11.6% of the participants and was a significant risk factor for sleep-disordered breathing (p<0.001), while it was not a significant risk factor for snoring (p=0.079). The frequency of witnessed sleep apnea is 2.3%, and it is positively related to both habitual snoring (p=0.001) and sleep-disordered breathing (p<0.001). Morbidities such as enuresis nocturna, morning headache, growth retardation, being overweight, attention deficit and hyperactivity disorder were found to be statistically significantly more common in patients with sleep-disordered breathing. It was observed that habitual snoring was accompanied by physical and behavioral problems except being overweight (p=0.081). Conclusion: Sleep-disordered breathing is a common disease and causes severe health problems in children. In our study, we determined the prevalence of snoring and sleep-disordered breathing in primary school children. We also showed that snoring is associated with chronic complications and increases the risk of sleep apnea. We confirmed that undiagnosed children can be detected by school surveys and questionnaire studies. It is a fact that access to sleep laboratories is limited worldwide and it is costly to perform polysomnography on all children with symptoms. Therefore, the use of sleep questionnaires is a useful method for risk assessment, early diagnosis and treatment, especially for children with physical and behavioral difficulties. Keywords: Sleep-disordered breathing, snoring, prevalence, pediatric sleep questionnaire