title: Seasonal trends in sleep-disordered breathing: evidence from Internet search engine query data.
abstract: OBJECTIVE
  The primary aim of the current study was to test the hypothesis that there is a seasonal component to snoring and obstructive sleep apnea (OSA) through the use of Google search engine query data.
  
  
  METHODS
  Internet search engine query data were retrieved from Google Trends from January 2006 to December 2012. Monthly normalized search volume was obtained over that 7-year period in the USA and Australia for the following search terms: "snoring" and "sleep apnea". Seasonal effects were investigated by fitting cosinor regression models. In addition, the search terms "snoring children" and "sleep apnea children" were evaluated to examine seasonal effects in pediatric populations.
  
  
  RESULTS
  Statistically significant seasonal effects were found using cosinor analysis in both USA and Australia for "snoring" (p < 0.00001 for both countries). Similarly, seasonal patterns were observed for "sleep apnea" in the USA (p = 0.001); however, cosinor analysis was not significant for this search term in Australia (p = 0.13). Seasonal patterns for "snoring children" and "sleep apnea children" were observed in the USA (p = 0.002 and p < 0.00001, respectively), with insufficient search volume to examine these search terms in Australia. All searches peaked in the winter or early spring in both countries, with the magnitude of seasonal effect ranging from 5 to 50 %.
  
  
  CONCLUSIONS
  Our findings indicate that there are significant seasonal trends for both snoring and sleep apnea internet search engine queries, with a peak in the winter and early spring. Further research is indicated to determine the mechanisms underlying these findings, whether they have clinical impact, and if they are associated with other comorbid medical conditions that have similar patterns of seasonal exacerbation.
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, dingram@uwhealth.org.
authors.forename: David G
authors.initials: DG
authors.lastname: Ingram
authors.forename: Camilla K
authors.initials: CK
authors.lastname: Matthews
authors.forename: David T
authors.initials: DT
authors.lastname: Plante
mesh_terms: D000328:Adult; D001315:Australia; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D057386:Search Engine; D012621:Seasons; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D012913:Snoring / Q000453:epidemiology; D014481:United States