title: An anatomically based analysis of objectively measured pediatric snoring: a pilot study.
abstract: OBJECTIVE
  To assess pediatric habitual snoring (PS) using home sleep test (HST) technology and attempt to correlate the objective components of PS to specific upper airway anatomy. In addition, the effects of adenotonsillectomy (±turbinoplasty) on objective measures of PS were evaluated.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  Pediatric patients with a chief complaint of snoring and probable obstructive sleep apnea underwent an HST (SNAP Diagnostics, Wheeling, Illinois) with a detailed acoustical snoring analysis prior to adenotonsillectomy (±turbinoplasty). During surgery, detailed anatomical measurements were performed and correlated to snoring analysis results. After surgery, patients were offered another HST with snoring analysis. Data analysis was performed using descriptive statistics and statistical correlation with attention to the multiple-comparisons paradox.
  
  
  RESULTS
  Twenty-two patients (45% male; mean age, 5.4 years [range, 2.4-8.4 years]) completed the preoperative HST and operative measurements. Unlike typical adult snoring, only a minority of PS was from palatal flutter (mean palatal component, 24%; median, 10%). The resistance occurrence percentage (ROP, percentage of breathing events with snoring noise) was associated with body mass index (BMI; Spearman ρ=0.55; P=.017), subjective turbinate size (0.54; P=.032), palatal obstruction (0.63; P=.008), and mean oxygen saturation (-0.729; P=.0003) but not adenotonsillar hypertrophy. Twelve patients (54%) completed a postoperative HST. The ROP was significantly reduced (median, 20.5% vs 6.5%; P=.006, sign rank test) postoperatively. The magnitude of the ROP reduction was proportional to the volume of the removed tonsils (0.74; P=.022).
  
  
  CONCLUSIONS
  Pediatric snoring has different acoustical characteristics than adult snoring. Objective PS is associated with BMI, turbinate size, and palatal obstruction. Adenotonsillectomy (±turbinoplasty) may significantly reduce objective PS.
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland, USA Uniformed Services University of the Health Sciences Bethesda, Maryland, USA SEBrietzke@msn.com.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brietzke
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: Max D
authors.initials: MD
authors.lastname: Pusz
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy; D008297:Male; D010865:Pilot Projects; D017286:Polysomnography; D011446:Prospective Studies; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D012913:Snoring / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D014068:Tonsillectomy; D014420:Turbinates / Q000473:pathology*
keywords: adenoidectomy; home sleep study; snoring; tonsillectomy; turbinates