title: Sleep-disordered breathing is a risk factor for community-acquired alveolar pneumonia in early childhood.
abstract: BACKGROUND
  Data are scarce with regard to risk factors for acute community-acquired alveolar pneumonia (CAAP) in children, but it is known that children with sleep-disordered breathing (SDB) experience more respiratory infections. We aimed to assess whether SDB is a risk factor for CAAP in early childhood.
  
  
  METHODS
  We conducted a prospective, nested, case-control study assessing children < 5 years old who had been given a diagnosis of CAAP based on World Health Organization radiographic criteria. Demographic and clinical data were collected. SDB symptoms were documented using a structured questionnaire. CAAP study and retrospective sleep laboratory databases were compared. SDB presence and severity were determined by questionnaire and polysomnography (PSG).
  
  
  RESULTS
  A total of 14,913 children underwent chest radiography during the study period; 1,546 children with radiographically proven CAAP (58% boys) and 441 control subjects (54% boys) were prospectively enrolled. Frequent snoring was reported in 18.6% vs 2.9% subjects with CAAP and control subjects, respectively (P < .001). The respective figures for subjects with CAAP and control subjects for restless sleep, nocturnal breathing problems, abnormal behavior, and chronic rhinorrhea were 21.6% vs 5.3%, 5% vs 1.4%, 6.4% vs 0.2%, and 12.9% vs 1.8%, (P < .001 for each). Fifty children (3.3%) with CAAP vs three control subjects (0.7%) underwent adenoidectomy (P < .001). PSG diagnosis of obstructive sleep apnea had been established previously in 79 patients (5%) with CAAP vs six (1.3%) of the control subjects (OR, 3.7 [95% CI, 1.6-10.0]; P < .001), with higher severity in patients with CAAP than in control subjects.
  
  
  CONCLUSIONS
  SDB is common in children with CAAP and is possibly a predisposing risk factor for CAAP in children < 5 years old. We recommend considering SDB in young children who are given a diagnosis of CAAP.
authors.affiliation: Sleep-Wake Disorders Unit, Ben-Gurion University of the Negev, Beer Sheva, Jerusalem, Israel; Department of Pediatrics, Ben-Gurion University of the Negev, Beer Sheva, Jerusalem, Israel. Electronic address: avivgold@bgu.ac.il.
authors.forename: Aviv D
authors.initials: AD
authors.lastname: Goldbart
authors.affiliation: Sleep-Wake Disorders Unit, Ben-Gurion University of the Negev, Beer Sheva, Jerusalem, Israel; Department of Pediatrics, Ben-Gurion University of the Negev, Beer Sheva, Jerusalem, Israel.
authors.forename: Asher
authors.initials: A
authors.lastname: Tal
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Jerusalem, Israel.
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.affiliation: Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar-Ziv
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Jerusalem, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
mesh_terms: D000233:Adenoidectomy; D016022:Case-Control Studies; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D017286:Polysomnography; D011446:Prospective Studies; D011650:Pulmonary Alveoli; D011859:Radiography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D014068:Tonsillectomy