Apparent life-threatening events could be a wake-up call for sleep disordered breathing

Pediatr Pulmonol. 2016 Dec;51(12):1403-1408. doi: 10.1002/ppul.23468. Epub 2016 May 10.


Introduction: Polysomnographic recordings of children with an apparent life-threatening event (ALTE) have often displayed signs of partial or complete obstruction during sleep. Various studies have focused on facial dysmorphia in infants with ALTE and tried to establish a correlation between ALTE and obstructive sleep apnoea. Our study evaluates the phenotypic characteristics and the presence of sleep disorders in pre-school children who had at least one ALTE in the first year of life.

Materials and methods: We analyzed a group of pre-school children (mean age 5.21 ± 0.90 years) who were referred for an ALTE between 2008 and 2010. Children with no history of ALTEs were recruited as a control group. A detailed personal and family history was obtained for all the participants. Moreover, all the children underwent a general clinical examination and an ear, nose, and throat and orthodontic assessment. A clinical score was calculated according to the previously validated Sleep Clinical Record (SCR).

Results: In the ALTE group (n = 107), snoring (25.2% vs. 6.1%), apnoeas (19.6% vs. 4.3%), restless sleep (31.7% vs. 6.1%), and habitual mouth breathing (35.5% vs. 12.2%, P < 0.05) were significantly more common (P < 0.05) than in the control group (n = 115). The ALTE group also displayed a higher frequency of Angle class II (27.1% vs. 15.7%, P < 0.05), narrow palate (72.9% vs. 51.3%, P < 0.05), and Friedman palate position (grades III-IV) (31.7% vs. 16.6%, P < 0.05) than the control group. Moreover, 38/107 (35.5%) children in the ALTE group had a positive SCR score compared with 14/115 controls (12.2%) (P < 0.05).

Conclusions: Pre-school age children with previous ALTE had a higher frequency of sleep disordered breathing and malocclusion phenotypes. The occurrence of ALTEs may be predictive of the development of sleep disordered breathing and highlight the importance of a long-term follow-up. Pediatr Pulmonol. 2016;51:1403-1408. © 2016 Wiley Periodicals, Inc.

Keywords: infant pulmonary function; lung pathology; pulmonology (general); respiratory and airway muscle; sleep medicine.

MeSH terms

  • Case-Control Studies
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Malocclusion, Angle Class II / diagnosis
  • Malocclusion, Angle Class II / epidemiology*
  • Malocclusion, Angle Class II / physiopathology
  • Palate / abnormalities*
  • Polysomnography
  • Retrospective Studies
  • Sleep
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / epidemiology
  • Sleep Apnea Syndromes / physiopathology
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / epidemiology*
  • Sleep Apnea, Obstructive / physiopathology
  • Snoring / diagnosis
  • Snoring / epidemiology*
  • Snoring / physiopathology