Prevalence of childhood obstructive sleep apnoea syndrome and its role in daytime sleepiness in Syria: a large-scale school-based cross-sectional study

Mhd Obai Alchallah; Mhd Homam Safiah; Mohamed Motsem Belah Kajjoun; Khaled Kalalib Al Ashabi; Sham Ataya; Fatema Mohsen; Duaa Bakdounes; Muhammad Omar ElHomsi; Homam Alolabi; Dima Alistwani; Andrya Alzein; Ahmad Ayash; Lamaat Youzbashi; Louei Darjazini Nahas

doi:10.1097/MS9.0000000000000820

Prevalence of childhood obstructive sleep apnoea syndrome and its role in daytime sleepiness in Syria: a large-scale school-based cross-sectional study

Ann Med Surg (Lond). 2023 May 10;85(6):2579-2586. doi: 10.1097/MS9.0000000000000820. eCollection 2023 Jun.

Affiliations

¹ Faculty of Medicine.
² Faculty of Medicine, Damascus University, Damascus, Syria.
³ Division of Otorhinolaryngology, Department of Surgery, Faculty of Medicine, Syrian Private University.

Abstract

Obstructive sleep apnoea syndrome (OSAS) has become vastly conceded in the last decade as a possible reason for significant morbidity in childhood. This study aims to evaluate the prevalence of OSAS among school children and to assess the interrelationship between OSAS and daytime sleepiness.

Methods and materials: This cross-sectional study was conducted with 1029 children and adolescents aged 6-15 years attending elementary and secondary schools in Damascus, Syria. The questions involved 19 sleep problems items using the children sleep habits questionnaire, and 4 sleep disorder items (loud snoring, having snorts or gasps, breathing pauses, daytime sleepiness). Total sleep time (TST) was determined by sleep habits. Severe possible OSAS (p-OSAS) was addressed as having all OSA symptoms "frequently", and mild p-OSAS was defined as having any of the symptoms "sometimes". Severe and mild daytime sleepiness were rated as being very sleepy during the day "frequently", and "sometimes", respectively. Logistic regression was applied to predict risk factors of severe and mild daytime sleepiness.

Results: The prevalence of p-OSAS was 22.2%, of them 15.8% were mild, and 6.3% were severe. p-OSAS was more recognized in males 15.2% children (P<0.05). Most p-OSAS children sleep less than 6 h of TST; however; the mean TST was significantly lower at the secondary school level (P≤0.001). Predicted risk factors for severe and mild daytime sleepiness were students' grade level (P<0.05), severe and mild p-OSAS (P≤0.001), and TST less than 6 h (P≤0.001).

Conclusions: A significant number of children have p-OSAS, affecting daytime sleepiness in school age. Physicians should consider loud snoring, and breathing pauses as marked symptoms of severe daytime sleepiness. Moreover, raising parents awareness about OSAS and daytime sleepiness is essential to ensure early access to primary care.

Keywords: adolescence; daytime sleepiness; obstructive sleep apnoea; school children; sleep habits.