Prevalence of Self-Perceived Snoring and Apnea and Their Association with Daytime Sleepiness in Korean High School Students

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Abstract

Background and Purpose

There has been no nationwide population-based study of the prevalence of self-perceived snoring/apnea in Korean adolescents. The purpose of this study was to estimate prevalence of self-perceived snoring/apnea in Korean high-school students and to evaluate their association with daytime sleepiness.

Methods

An online survey was used to investigate 12,672 students at 75 high schools across the 15 nationwide districts of South Korea. The variables were obtained using a self-reported questionnaire. The students answered questions about self-perceived snoring/apnea during the past 30 days. Daytime sleepiness was measured using a validated Korean version of the Epworth Sleepiness Scale, which was modified for adolescents. Covariates were the sex, school grade, frequency of self-perceived snoring/apnea, body mass index, sleep duration during a school day, and subjective perception of sleep duration.

Results

The prevalence of self-perceived snoring/apnea was 22.8% (26.4% for males vs. 18.8% for females, p<0.001) and 9.2% (10.5% for males vs. 7.7% for females, p<0.001). Obesity was significantly associated with self-perceived snoring [odds ratio (OR)=2.18, 95% confidence interval (CI)=1.94–2.46] and apnea (OR=1.57, 95% CI=1.33–1.86). Multivariate analysis showed that any frequency of self-perceived snoring/apnea was significantly associated with excessive daytime sleepiness (EDS). The OR of EDS increased significantly with the frequency of snoring and apnea. Female, sleep duration of <5 hours during a school day, and subjective perceptions of insufficient and considerable sleep durations were also significantly associated with EDS.

Conclusions

The prevalence of self-perceived snoring/apnea was significantly higher in students who were male and obese. Students with self-perceived snoring/apnea exhibited more significant EDS and an increased risk of EDS as the frequency of snoring and apnea increased.

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Most cited references 26

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Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey.

Daniel L. Foley, Sonia Ancoli-Israel, Patricia Britz … (2004)

To assess the association between sleep problems and chronic disease in older adults. Self-reported standardized questionnaire data from 1506 community-dwelling men and women aged 55-84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of randomly selected telephone numbers. A majority of the participants (83%) reported one or more of 11 medical conditions and nearly one in four elderly respondents (age 65-84 years) had major comorbidity (i.e. four or more conditions). Depression, heart disease, bodily pain and memory problems were associated with more prevalent symptoms of insomnia. Other conditions such as obesity, arthritis, diabetes, lung diseases, stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses, snoring, daytime sleepiness, restless legs or insufficient sleep (<6 h nightly). Poll findings are consistent with epidemiological studies of sleep, aging and chronic disease. These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se. These types of studies may be useful in promoting sleep awareness among health professionals and among older adults, especially those with heart disease, depression, chronic bodily pain or major comorbidity.

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Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study.

Terry Young, Eyal Shahar, F Nieto … (2002)

Sleep-disordered breathing (SDB) is common, but largely undiagnosed in the general population. Information on demographic patterns of SDB occurrence and its predictive factors in the general population is needed to target high-risk groups that may benefit from diagnosis. The sample comprised 5615 community-dwelling men and women aged between 40 and 98 years who were enrolled in the Sleep Heart Health Study. Data were collected by questionnaire, clinical examinations, and in-home polysomnography. Sleep-disordered breathing status was based on the average number of apnea and hypopnea episodes per hour of sleep (apnea-hypopnea index [AHI]). We used multiple logistic regression modeling to estimate cross-sectional associations of selected participant characteristics with SDB defined by an AHI of 15 or greater. Male sex, age, body mass index, neck girth, snoring, and repeated breathing pause frequency were independent, significant correlates of an AHI of 15 or greater. People reporting habitual snoring, loud snoring, and frequent breathing pauses were 3 to 4 times more likely to have an AHI of 15 or greater vs an AHI less than 15, but there were weaker associations for other factors with an AHI of 15 or greater. The odds ratios (95% confidence interval) for an AHI of 15 or greater vs an AHI less than 15 were 1.6 and 1.5, respectively, for 1-SD increments in body mass index and neck girth. As age increased, the magnitude of associations for SDB and body habitus, snoring, and breathing pauses decreased. A significant proportion of occult SDB in the general population would be missed if screening or case finding were based solely on increased body habitus or male sex. Breathing pauses and obesity may be particularly insensitive for identifying SDB in older people. A better understanding of predictive factors for SDB, particularly in older adults, is needed.

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Sleep-disordered breathing and school performance in children.

D Gozal (1998)

To assess the impact of sleep-associated gas exchange abnormalities (SAGEA) on school academic performance in children. Prospective study. Urban public elementary schools. Two hundred ninety-seven first-grade children whose school performance was in the lowest 10th percentile of their class ranking. Children were screened for obstructive sleep apnea syndrome at home using a detailed parental questionnaire and a single night recording of pulse oximetry and transcutaneous partial pressure of carbon dioxide. If SAGEA was diagnosed, parents were encouraged to seek medical intervention for SAGEA. School grades of all participating children for the school year preceding and after the overnight study were obtained. SAGEA was identified in 54 children (18.1%). Of these, 24 underwent surgical tonsillectomy and adenoidectomy (TR), whereas in the remaining 30 children, parents elected not to seek any therapeutic intervention (NT). Overall mean grades during the second grade increased from 2.43 +/- 0.17 (SEM) to 2.87 +/- 0.19 in TR, although no significant changes occurred in NT (2.44 +/- 0.13 to 2.46 +/- 0.15). Similarly, no academic improvements occurred in children without SAGEA. SAGEA is frequently present in poorly performing first-grade students in whom it adversely affects learning performance. The data suggest that a subset of children with behavioral and learning disabilities could have SAGEA and may benefit from prospective medical evaluation and treatment.

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Author and article information

Journal

Journal ID (nlm-ta): J Clin Neurol

Journal ID (iso-abbrev): J Clin Neurol

Journal ID (publisher-id): JCN

Title: Journal of Clinical Neurology (Seoul, Korea)

Publisher: Korean Neurological Association

ISSN (Print): 1738-6586

ISSN (Electronic): 2005-5013

Publication date (Print): July 2017

Publication date (Electronic): 30 June 2017

Volume: 13

Issue: 3

Pages: 265-272

Affiliations

[a ]Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.

[b ]Department of Neurology, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Korea.

[c ]Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.

[d ]Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea.

[e ]Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea.

[f ]Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea.

[g ]Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea.

Author notes

Correspondence: Kwang Ik Yang, MD, PhD. Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea. Tel +82-41-570-2290, Fax +82-41-592-3810, neurofan@ 123456schmc.ac.kr

Correspondence: Seung Bong Hong, MD, PhD. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel +82-2-3410-3592, Fax +82-2-3410-0052, sbhong@ 123456skku.edu

Article

DOI: 10.3988/jcn.2017.13.3.265

PMC ID: 5532323

PubMed ID: 28748678

SO-VID: d08bca77-9601-4b4f-b5be-bbafa2799ff7

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 24 November 2016

Date revision received : 11 April 2017

Date accepted : 11 April 2017

Funding

Funded by: Korea Health Industry Development Institute, CrossRef http://dx.doi.org/10.13039/501100003710;

Award ID: HI16C1643

Funded by: Korea Centers for Disease Control & Prevention, CrossRef http://dx.doi.org/10.13039/501100003669;

Prevalence of Self-Perceived Snoring and Apnea and Their Association with Daytime Sleepiness in Korean High School Students

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Abstract

Background and Purpose

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Results

Conclusions

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Karger: Neurology and Neuroscience

Most cited references 26

Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey.

Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study.

Sleep-disordered breathing and school performance in children.

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