title: Caregiver perception of sleep-disordered breathing-associated symptoms in children of rural Andean communities above 4000 masl with chronic exposure to biomass fuel.
abstract: BACKGROUND
  Previous studies have uncovered a very high prevalence of sleep disorders in general, and of sleep-disordered breathing in particular among children exposed to indoor biomass fuel pollution. However, despite the significant symptomatology, parents are unlikely to report these issues during health-care visits.
  
  
  OBJECTIVE
  The objective of this study was to determine whether reduced caregiver perception of sleep disorders may account for the infrequent diagnosis and treatment of such problems in children residing at high altitudes and exposed to high biomass pollution.
  
  
  METHODS
  Parents of children aged 9-15 years of three communities residing in the Pasco region in Peru located between 3800 and 4200 meters above sea level were surveyed using a validated questionnaire instrument focused on symptoms associated with sleep-disordered breathing as well as whether caregivers perceived that their child suffered from a sleep disorder.
  
  
  RESULTS
  Among the 77 children included, 48.1% had nocturnal awakenings and 46.8% had repetitive movements and restless sleep. Habitual snoring was present in 33.8% of all children. However, only 10.4% of mothers considered that their children had sleep problems, and all of their children had positive answers for ≥4 sleep symptoms.
  
  
  CONCLUSIONS
  Children residing at high altitudes and exposed to traditional biomass-fueled stoves exhibit an extremely high frequency of sleep symptoms that are misperceived by their mothers as being "normal." Interventions aimed at increasing parental recognition and awareness of sleep problems will be essential to foster improved diagnosis and treatment.
authors.affiliation: Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Nacional Cayetano Heredia, Lima, Peru; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Accinelli
authors.affiliation: Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Oscar
authors.initials: O
authors.lastname: Llanos
authors.affiliation: Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Lidia M
authors.initials: LM
authors.lastname: López
authors.affiliation: Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Matayoshi
authors.affiliation: Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Yuliana P
authors.initials: YP
authors.lastname: Oros
authors.affiliation: Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
authors.forename: Leila
authors.initials: L
authors.lastname: Kheirandish-Gozal
authors.affiliation: Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. Electronic address: dgozal@uchicago.edu.
authors.forename: David
authors.initials: D
authors.lastname: Gozal
mesh_terms: D000293:Adolescent; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D000531:Altitude; D001294:Attitude to Health; D056804:Biofuels / Q000009:adverse effects*; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010568:Peru; D012424:Rural Population; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D056804:Biofuels
keywords: Biomass pollution; Perception; Respiratory morbidity; Sleep disorders