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. 1995 Nov;50(11):1204–1210. doi: 10.1136/thx.50.11.1204

Sleep-related breathing disorders. 6. Obstructive sleep apnoea syndrome in infants and children: established facts and unsettled issues.

C Gaultier 1
PMCID: PMC475096  PMID: 8553280

Abstract

The presence of increased upper airway resistive loads during sleep can now be diagnosed by paediatricians. However, diagnostic criteria need to be further clarified to allow accurate identification of episodes of partial airway obstruction. New technological advances can be expected to help to determine the clinical usefulness of ambulatory testing during sleep and thus to establish the indications for polysomnographic investigations in the laboratory. A thorough investigation of the anatomical abnormalities that contribute to airways obstruction is essential for selecting the most appropriate therapy. However, the order in which these investigations should be performed remains unclear. The diagnostic tools, including questionnaires and sleep testing, and methods aimed at investigating pathophysiological mechanisms should be standardised for multicentre studies. Familial factors should be taken into account. The best strategy for preventing the complications of the OSA syndrome is to identify the disorder as early as possible. This requires close cooperation between adult physicians and paediatricians called upon to evaluate sleep-related disorders.

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Selected References

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  1. Ahlqvist-Rastad J., Hultcrantz E., Svanholm H. Children with tonsillar obstruction: indications for and efficacy of tonsillectomy. Acta Paediatr Scand. 1988 Nov;77(6):831–835. doi: 10.1111/j.1651-2227.1988.tb10764.x. [DOI] [PubMed] [Google Scholar]
  2. Ali N. J., Pitson D. J., Stradling J. R. Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child. 1993 Mar;68(3):360–366. doi: 10.1136/adc.68.3.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Biban P., Baraldi E., Pettennazzo A., Filippone M., Zacchello F. Adverse effect of chloral hydrate in two young children with obstructive sleep apnea. Pediatrics. 1993 Sep;92(3):461–463. [PubMed] [Google Scholar]
  4. Brodsky L., Adler E., Stanievich J. F. Naso- and oropharyngeal dimensions in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 1989 Feb;17(1):1–11. doi: 10.1016/0165-5876(89)90288-7. [DOI] [PubMed] [Google Scholar]
  5. Brouilette R., Hanson D., David R., Klemka L., Szatkowski A., Fernbach S., Hunt C. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr. 1984 Jul;105(1):10–14. doi: 10.1016/s0022-3476(84)80348-0. [DOI] [PubMed] [Google Scholar]
  6. Brouillette R. T., Fernbach S. K., Hunt C. E. Obstructive sleep apnea in infants and children. J Pediatr. 1982 Jan;100(1):31–40. doi: 10.1016/s0022-3476(82)80231-x. [DOI] [PubMed] [Google Scholar]
  7. Canet E., Gaultier C., D'Allest A. M., Dehan M. Effects of sleep deprivation on respiratory events during sleep in healthy infants. J Appl Physiol (1985) 1989 Mar;66(3):1158–1163. doi: 10.1152/jappl.1989.66.3.1158. [DOI] [PubMed] [Google Scholar]
  8. Carroll J. L., Loughlin G. M. Diagnostic criteria for obstructive sleep apnea syndrome in children. Pediatr Pulmonol. 1992 Oct;14(2):71–74. doi: 10.1002/ppul.1950140202. [DOI] [PubMed] [Google Scholar]
  9. Carskadon M. A., Harvey K., Dement W. C., Guilleminault C., Simmons F. B., Anders T. F. Respiration during sleep in children. West J Med. 1978 Jun;128(6):477–481. [PMC free article] [PubMed] [Google Scholar]
  10. Contencin P., Nottet J. B., Yacoubian K., Soussi T., Nivoche Y., Narcy P. Pharyngo-laryngo-fibroscopie sous anesthésie générale chez l'enfant. Technique et indications dans les apnées/hypopnées du sommeil. Ann Otolaryngol Chir Cervicofac. 1991;108(7):373–377. [PubMed] [Google Scholar]
  11. Croft C. B., Brockbank M. J., Wright A., Swanston A. R. Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy. Clin Otolaryngol Allied Sci. 1990 Aug;15(4):307–314. doi: 10.1111/j.1365-2273.1990.tb00474.x. [DOI] [PubMed] [Google Scholar]
  12. D'Andrea L. A., Rosen C. L., Haddad G. G. Severe hypoxemia in children with upper airway obstruction during sleep does not lead to significant changes in heart rate. Pediatr Pulmonol. 1993 Dec;16(6):362–369. doi: 10.1002/ppul.1950160608. [DOI] [PubMed] [Google Scholar]
  13. Davies S. C., Stebbens V. A., Samuels M. P., Southall D. P. Upper airways obstruction and cerebrovascular accident in children with sickle cell anaemia. Lancet. 1989 Jul 29;2(8657):283–284. doi: 10.1016/s0140-6736(89)90477-7. [DOI] [PubMed] [Google Scholar]
  14. Davies S. C., Stebbens V. A., Samuels M. P., Southall D. P. Upper airways obstruction and cerebrovascular accident in children with sickle cell anaemia. Lancet. 1989 Jul 29;2(8657):283–284. doi: 10.1016/s0140-6736(89)90477-7. [DOI] [PubMed] [Google Scholar]
  15. Douglas N. J., Luke M., Mathur R. Is the sleep apnoea/hypopnoea syndrome inherited? Thorax. 1993 Jul;48(7):719–721. doi: 10.1136/thx.48.7.719. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Dure L. S., Percy A. K., Cheek W. R., Laurent J. P. Chiari type I malformation in children. J Pediatr. 1989 Oct;115(4):573–576. doi: 10.1016/s0022-3476(89)80283-5. [DOI] [PubMed] [Google Scholar]
  17. Fan L. L. Transnasal fiberoptic endoscopy in children with obstructive apnea. Crit Care Med. 1984 Jul;12(7):590–592. doi: 10.1097/00003246-198407000-00009. [DOI] [PubMed] [Google Scholar]
  18. Fernbach S. K., Brouillette R. T., Riggs T. W., Hunt C. E. Radiologic evaluation of adenoids and tonsils in children with obstructive sleep apnea: plain films and fluoroscopy. Pediatr Radiol. 1983;13(5):258–265. doi: 10.1007/BF00973342. [DOI] [PubMed] [Google Scholar]
  19. Frank Y., Kravath R. E., Pollak C. P., Weitzman E. D. Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations. Pediatrics. 1983 May;71(5):737–742. [PubMed] [Google Scholar]
  20. François M., Elmaleh M., Garel C., Narcy P. Dimensions du pharynx en fonction de la position, chez le nouveau-né et le nourrisson. Arch Fr Pediatr. 1992 Jan;49(1):23–26. [PubMed] [Google Scholar]
  21. Goldstein S. J., Wu R. H., Thorpy M. J., Shprintzen R. J., Marion R. E., Saenger P. Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea. Acta Endocrinol (Copenh) 1987 Sep;116(1):95–101. doi: 10.1530/acta.0.1160095. [DOI] [PubMed] [Google Scholar]
  22. Gould G. A., Whyte K. F., Rhind G. B., Airlie M. A., Catterall J. R., Shapiro C. M., Douglas N. J. The sleep hypopnea syndrome. Am Rev Respir Dis. 1988 Apr;137(4):895–898. doi: 10.1164/ajrccm/137.4.895. [DOI] [PubMed] [Google Scholar]
  23. Guilleminault C., Ariagno R., Korobkin R., Nagel L., Baldwin R., Coons S., Owen M. Mixed and obstructive sleep apnea and near miss for sudden infant death syndrome: 2. Comparison of near miss and normal control infants by age. Pediatrics. 1979 Dec;64(6):882–891. [PubMed] [Google Scholar]
  24. Guilleminault C., Connolly S., Winkle R., Melvin K., Tilkian A. Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique. Lancet. 1984 Jan 21;1(8369):126–131. doi: 10.1016/s0140-6736(84)90062-x. [DOI] [PubMed] [Google Scholar]
  25. Guilleminault C., Eldridge F. L., Simmons F. B., Dement W. C. Sleep apnea in eight children. Pediatrics. 1976 Jul;58(1):23–30. [PubMed] [Google Scholar]
  26. Guilleminault C., Korobkin R., Winkle R. A review of 50 children with obstructive sleep apnea syndrome. Lung. 1981;159(5):275–287. doi: 10.1007/BF02713925. [DOI] [PubMed] [Google Scholar]
  27. Guilleminault C., Nino-Murcia G., Heldt G., Baldwin R., Hutchinson D. Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: nasal continuous positive airway pressure in young children. Pediatrics. 1986 Nov;78(5):797–802. [PubMed] [Google Scholar]
  28. Guilleminault C. Obstructive sleep apnea syndrome and its treatment in children: areas of agreement and controversy. Pediatr Pulmonol. 1987 Nov-Dec;3(6):429–436. doi: 10.1002/ppul.1950030610. [DOI] [PubMed] [Google Scholar]
  29. Guilleminault C., Partinen M., Praud J. P., Quera-Salva M. A., Powell N., Riley R. Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr. 1989 Jun;114(6):997–999. doi: 10.1016/s0022-3476(89)80447-0. [DOI] [PubMed] [Google Scholar]
  30. Guilleminault C., Souquet M., Ariagno R. L., Korobkin R., Simmons F. B. Five cases of near-miss sudden infant death syndrome and development of obstructive sleep apnea syndrome. Pediatrics. 1984 Jan;73(1):71–78. [PubMed] [Google Scholar]
  31. Guilleminault C., Stoohs R. From apnea of infancy to obstructive sleep apnea syndrome in the young child. Chest. 1992 Oct;102(4):1065–1071. doi: 10.1378/chest.102.4.1065. [DOI] [PubMed] [Google Scholar]
  32. Guilleminault C., Stoohs R., Skrobal A., Labanowski M., Simmons J. Upper airway resistance in infants at risk for sudden infant death syndrome. J Pediatr. 1993 Jun;122(6):881–886. doi: 10.1016/s0022-3476(09)90011-7. [DOI] [PubMed] [Google Scholar]
  33. Guilleminault C., Winkle R., Korobkin R., Simmons B. Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr. 1982 Nov;139(3):165–171. doi: 10.1007/BF01377349. [DOI] [PubMed] [Google Scholar]
  34. Gunn T. R., Tonkin S. L. Upper airway measurements during inspiration and expiration in infants. Pediatrics. 1989 Jul;84(1):73–77. [PubMed] [Google Scholar]
  35. Hershenson M., Brouillette R. T., Olsen E., Hunt C. E. The effect of chloral hydrate on genioglossus and diaphragmatic activity. Pediatr Res. 1984 Jun;18(6):516–519. doi: 10.1203/00006450-198406000-00006. [DOI] [PubMed] [Google Scholar]
  36. Hertz G., Cataletto M., Feinsilver S. H., Angulo M. Sleep and breathing patterns in patients with Prader Willi syndrome (PWS): effects of age and gender. Sleep. 1993 Jun;16(4):366–371. doi: 10.1093/sleep/16.4.366. [DOI] [PubMed] [Google Scholar]
  37. Hoppenbrouwers T., Hodgman J. E., Cabal L. Obstructive apnea, associated patterns of movement, heart rate, and oxygenation in infants at low and increased risk for SIDS. Pediatr Pulmonol. 1993 Jan;15(1):1–12. doi: 10.1002/ppul.1950150102. [DOI] [PubMed] [Google Scholar]
  38. Hunt C. E., Brouillette R. T. Abnormalities of breathing control and airway maintenance in infants and children as a cause of cor pulmonale. Pediatr Cardiol. 1982;3(3):249–256. doi: 10.1007/BF02240461. [DOI] [PubMed] [Google Scholar]
  39. Ingram R. H., Bishop J. B. Ventilatory response to carbon dioxide after removal of chronic upper airway obstruction. Am Rev Respir Dis. 1970 Oct;102(4):645–647. doi: 10.1164/arrd.1970.102.4.645. [DOI] [PubMed] [Google Scholar]
  40. Jeans W. D., Fernando D. C., Maw A. R., Leighton B. C. A longitudinal study of the growth of the nasopharynx and its contents in normal children. Br J Radiol. 1981 Feb;54(638):117–121. doi: 10.1259/0007-1285-54-638-117. [DOI] [PubMed] [Google Scholar]
  41. Jeffries B., Brouillette R. T., Hunt C. E. Electromyographic study of some accessory muscles of respiration in children with obstructive sleep apnea. Am Rev Respir Dis. 1984 May;129(5):696–702. doi: 10.1164/arrd.1984.129.5.696. [DOI] [PubMed] [Google Scholar]
  42. Kahn A., Groswasser J., Rebuffat E., Sottiaux M., Blum D., Foerster M., Franco P., Bochner A., Alexander M., Bachy A. Sleep and cardiorespiratory characteristics of infant victims of sudden death: a prospective case-control study. Sleep. 1992 Aug;15(4):287–292. doi: 10.1093/sleep/15.4.287. [DOI] [PubMed] [Google Scholar]
  43. Kahn A., Groswasser J., Sottiaux M., Rebuffat E., Sunseri M., Franco P., Dramaix M., Bochner A., Belhadi B., Foerster M. Clinical symptoms associated with brief obstructive sleep apnea in normal infants. Sleep. 1993 Aug;16(5):409–413. doi: 10.1093/sleep/16.5.409. [DOI] [PubMed] [Google Scholar]
  44. Kahn A., Mozin M. J., Rebuffat E., Sottiaux M., Burniat W., Shepherd S., Muller M. F. Sleep pattern alterations and brief airway obstructions in overweight infants. Sleep. 1989 Oct;12(5):430–438. doi: 10.1093/sleep/12.5.430. [DOI] [PubMed] [Google Scholar]
  45. LODIN Z., NOVAKOVA V., PILN'Y J., MED F., HARTMAN J. THE USE OF PLANIMETRY IN CYTOLOGY. Physiol Bohemoslov. 1963;12:590–598. [PubMed] [Google Scholar]
  46. Laitinen S. H., Ranta R. E. Cephalometric measurements in patients with Pierre Robin syndrome and isolated cleft palate. Scand J Plast Reconstr Surg Hand Surg. 1992;26(2):177–183. doi: 10.3109/02844319209016010. [DOI] [PubMed] [Google Scholar]
  47. Levy A. M., Tabakin B. S., Hanson J. S., Narkewicz R. M. Hypertrophied adenoids causing pulmonary hypertension and severe congestive heart failure. N Engl J Med. 1967 Sep 7;277(10):506–511. doi: 10.1056/NEJM196709072771003. [DOI] [PubMed] [Google Scholar]
  48. Mallory G. B., Jr, Fiser D. H., Jackson R. Sleep-associated breathing disorders in morbidly obese children and adolescents. J Pediatr. 1989 Dec;115(6):892–897. doi: 10.1016/s0022-3476(89)80738-3. [DOI] [PubMed] [Google Scholar]
  49. Marcus C. L., Carroll J. L., Koerner C. B., Hamer A., Lutz J., Loughlin G. M. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr. 1994 Oct;125(4):556–562. doi: 10.1016/s0022-3476(94)70007-9. [DOI] [PubMed] [Google Scholar]
  50. Marcus C. L., Crockett D. M., Ward S. L. Evaluation of epiglottoplasty as treatment for severe laryngomalacia. J Pediatr. 1990 Nov;117(5):706–710. doi: 10.1016/s0022-3476(05)83325-6. [DOI] [PubMed] [Google Scholar]
  51. Marcus C. L., Gozal D., Arens R., Basinski D. J., Omlin K. J., Keens T. G., Ward S. L. Ventilatory responses during wakefulness in children with obstructive sleep apnea. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):715–721. doi: 10.1164/ajrccm.149.3.8118641. [DOI] [PubMed] [Google Scholar]
  52. Marcus C. L., Keens T. G., Bautista D. B., von Pechmann W. S., Ward S. L. Obstructive sleep apnea in children with Down syndrome. Pediatrics. 1991 Jul;88(1):132–139. [PubMed] [Google Scholar]
  53. Marcus C. L., Keens T. G., Ward S. L. Comparison of nap and overnight polysomnography in children. Pediatr Pulmonol. 1992 May;13(1):16–21. doi: 10.1002/ppul.1950130106. [DOI] [PubMed] [Google Scholar]
  54. Marcus C. L., McColley S. A., Carroll J. L., Loughlin G. M., Smith P. L., Schwartz A. R. Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Physiol (1985) 1994 Aug;77(2):918–924. doi: 10.1152/jappl.1994.77.2.918. [DOI] [PubMed] [Google Scholar]
  55. Marcus C. L., Omlin K. J., Basinki D. J., Bailey S. L., Rachal A. B., Von Pechmann W. S., Keens T. G., Ward S. L. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis. 1992 Nov;146(5 Pt 1):1235–1239. doi: 10.1164/ajrccm/146.5_Pt_1.1235. [DOI] [PubMed] [Google Scholar]
  56. Messer J., Erny P., Stierle J. L., Alt R. Hypoventilation alvéolaire du sommeil au cours de l'obstruction pharyngée par hypertrophie lymphoïde chez l'enfant. Arch Fr Pediatr. 1984 May;41(5):333–336. [PubMed] [Google Scholar]
  57. Miyazaki S., Itasaka Y., Yamakawa K., Okawa M., Togawa K. Respiratory disturbance during sleep due to adenoid-tonsillar hypertrophy. Am J Otolaryngol. 1989 Mar-Apr;10(2):143–149. doi: 10.1016/0196-0709(89)90138-5. [DOI] [PubMed] [Google Scholar]
  58. Morrison D. L., Launois S. H., Isono S., Feroah T. R., Whitelaw W. A., Remmers J. E. Pharyngeal narrowing and closing pressures in patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 Sep;148(3):606–611. doi: 10.1164/ajrccm/148.3.606. [DOI] [PubMed] [Google Scholar]
  59. Onal E., Lopata M., O'Connor T. Pathogenesis of apneas in hypersomnia-sleep apnea syndrome. Am Rev Respir Dis. 1982 Feb;125(2):167–174. doi: 10.1164/arrd.1982.125.2.167. [DOI] [PubMed] [Google Scholar]
  60. Potsic W. P. Comparison of polysomnography and sonography for assessing regularity of respiration during sleep in adenotonsillar hypertrophy. Laryngoscope. 1987 Dec;97(12):1430–1437. doi: 10.1288/00005537-198712000-00010. [DOI] [PubMed] [Google Scholar]
  61. Potsic W. P., Pasquariello P. S., Baranak C. C., Marsh R. R., Miller L. M. Relief of upper airway obstruction by adenotonsillectomy. Otolaryngol Head Neck Surg. 1986 Apr;94(4):476–480. doi: 10.1177/019459988609400412. [DOI] [PubMed] [Google Scholar]
  62. Praud J. P., D'Allest A. M., Delaperche M. F., Bobin S., Gaultier C. Diaphragmatic and genioglossus electromyographic activity at the onset and at the end of obstructive apnea in children with obstructive sleep apnea syndrome. Pediatr Res. 1988 Jan;23(1):1–4. doi: 10.1203/00006450-198801000-00001. [DOI] [PubMed] [Google Scholar]
  63. Praud J. P., D'Allest A. M., Nedelcoux H., Curzi-Dascalova L., Guilleminault C., Gaultier C. Sleep-related abdominal muscle behavior during partial or complete obstructed breathing in prepubertal children. Pediatr Res. 1989 Oct;26(4):347–350. doi: 10.1203/00006450-198910000-00012. [DOI] [PubMed] [Google Scholar]
  64. Praud J. P., Gaultier C., Buvry A., Boule M., Girard F. Lung mechanics and breathing pattern during wakefulness and sleep in children with enlarged tonsils. Sleep. 1984;7(4):304–312. doi: 10.1093/sleep/7.4.304. [DOI] [PubMed] [Google Scholar]
  65. Redline S., Tosteson T., Tishler P. V., Carskadon M. A., Millman R. P., Milliman R. P. Studies in the genetics of obstructive sleep apnea. Familial aggregation of symptoms associated with sleep-related breathing disturbances. Am Rev Respir Dis. 1992 Feb;145(2 Pt 1):440–444. doi: 10.1164/ajrccm/145.2_Pt_1.440. [DOI] [PubMed] [Google Scholar]
  66. Roberts J. L., Reed W. R., Mathew O. P., Menon A. A., Thach B. T. Assessment of pharyngeal airway stability in normal and micrognathic infants. J Appl Physiol (1985) 1985 Jan;58(1):290–299. doi: 10.1152/jappl.1985.58.1.290. [DOI] [PubMed] [Google Scholar]
  67. Roberts J. L., Reed W. R., Mathew O. P., Thach B. T. Control of respiratory activity of the genioglossus muscle in micrognathic infants. J Appl Physiol (1985) 1986 Oct;61(4):1523–1533. doi: 10.1152/jappl.1986.61.4.1523. [DOI] [PubMed] [Google Scholar]
  68. Rosen C. L., D'Andrea L., Haddad G. G. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis. 1992 Nov;146(5 Pt 1):1231–1234. doi: 10.1164/ajrccm/146.5_Pt_1.1231. [DOI] [PubMed] [Google Scholar]
  69. Sher A. E. Mechanisms of airway obstruction in Robin sequence: implications for treatment. Cleft Palate Craniofac J. 1992 May;29(3):224–231. doi: 10.1597/1545-1569_1992_029_0224_moaoir_2.3.co_2. [DOI] [PubMed] [Google Scholar]
  70. Shintani T., Asakura K., Kataura A. Obstructive sleep apnea in children. Adv Otorhinolaryngol. 1992;47:267–270. doi: 10.1159/000421755. [DOI] [PubMed] [Google Scholar]
  71. Silvestri J. M., Weese-Mayer D. E., Bass M. T., Kenny A. S., Hauptman S. A., Pearsall S. M. Polysomnography in obese children with a history of sleep-associated breathing disorders. Pediatr Pulmonol. 1993 Aug;16(2):124–129. doi: 10.1002/ppul.1950160208. [DOI] [PubMed] [Google Scholar]
  72. Spier S., Rivlin J., Rowe R. D., Egan T. Sleep in Pierre Robin syndrome. Chest. 1986 Nov;90(5):711–715. doi: 10.1378/chest.90.5.711. [DOI] [PubMed] [Google Scholar]
  73. Stradling J. R., Thomas G., Warley A. R., Williams P., Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990 Feb 3;335(8684):249–253. doi: 10.1016/0140-6736(90)90068-g. [DOI] [PubMed] [Google Scholar]
  74. Tabachnik E., Muller N. L., Bryan A. C., Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Physiol Respir Environ Exerc Physiol. 1981 Sep;51(3):557–564. doi: 10.1152/jappl.1981.51.3.557. [DOI] [PubMed] [Google Scholar]
  75. Tal A., Leiberman A., Margulis G., Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol. 1988;4(3):139–143. doi: 10.1002/ppul.1950040304. [DOI] [PubMed] [Google Scholar]
  76. Teculescu D. B., Caillier I., Perrin P., Rebstock E., Rauch A. Snoring in French preschool children. Pediatr Pulmonol. 1992 Aug;13(4):239–244. doi: 10.1002/ppul.1950130412. [DOI] [PubMed] [Google Scholar]
  77. Thoppil C. K., Belan M. A., Cowen C. P., Mathew O. P. Behavioral arousal in newborn infants and its association with termination of apnea. J Appl Physiol (1985) 1991 Jun;70(6):2479–2484. doi: 10.1152/jappl.1991.70.6.2479. [DOI] [PubMed] [Google Scholar]
  78. Vargervik K., Harvold E. P. Experiments on the interaction between orofacial function and morphology. Ear Nose Throat J. 1987 May;66(5):201–208. [PubMed] [Google Scholar]
  79. Waters K. A., Everett F., Sillence D., Fagan E., Sullivan C. E. Breathing abnormalities in sleep in achondroplasia. Arch Dis Child. 1993 Aug;69(2):191–196. doi: 10.1136/adc.69.2.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Weider D. J., Hauri P. J. Nocturnal enuresis in children with upper airway obstruction. Int J Pediatr Otorhinolaryngol. 1985 Jul;9(2):173–182. doi: 10.1016/s0165-5876(85)80018-5. [DOI] [PubMed] [Google Scholar]
  81. Wilkinson A. R., McCormick M. S., Freeland A. P., Pickering D. Electrocardiographic signs of pulmonary hypertension in children who snore. Br Med J (Clin Res Ed) 1981 May 16;282(6276):1579–1581. doi: 10.1136/bmj.282.6276.1579. [DOI] [PMC free article] [PubMed] [Google Scholar]

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