ABSTRACT The aim of this study was to assess the prevalence of sleep-disordered breathing (SDB) symptoms among primary schoolchildren, and to objectively determine the influence of SDB on the intra-oral environment through the analysis of saliva. A questionnaire survey was conducted among approximately 400 children from a primary school in Hiroshima. Parents were asked to complete the questionnaire and provide their contact information if they allowed the collection of saliva samples from their children. Thirty-eight chil- dren agreed to participate in the saliva study. Habit- ual snoring and cessation of breathing during sleep were found in approximately 8% and 1% of children, respectively. The present results showed significant correlations between snoring and mouth breathing. A significant association between excessive daytime sle- epiness (EDS) and learning problems was found. Fur- thermore, among children between the ages of 7 and 12 years, those with EDS and learning problems tended to be older. SDB symptom scores were statisti- cally significant only in relation to EDS. The present study also demonstrated significantly higher levels of salivary IgA and cortisol in children with sleep-re- lated disorders. The present study determined the pre- valence and characteristics of SDB among Japanese primary schoolchildren and their effects on the oral environment. Approximately 8% of primary school- children with habitual snoring might need to be care- fully monitored for SDB symptoms and immune sta- tus to ensure proper psychological and physical deve- lopment.
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nullUeda, H. , Horihata, A. , Matsumoto, E. , Watanabe, G. , Koh, M. , Tanimoto, K. and Tanne, K. (2011) Immune function in Japanese schoolchildren with sleep-disordered breathing: a preliminary study with analyses of salivary markers. Open Journal of Stomatology, 1, 150-157. doi: 10.4236/ojst.2011.14022.
 American Academy of Pediatrics (2002) Clinical practice guideline: Diagnosis and management of childhood sleep apnea syndrome. Pediatrics, 109, 704-712.
 Ali, N.J., Pitson, D.J. and Stradling, J.R. (1993) Snoring, sleep disturbance and behaviour in 4 - 5 year olds. Archives of Disease in Childhood, 68, 360-366.
 Gottlieb, D.J., Vezina, R.M., Chase, C., Lesko, S.M., Heeren, T.C., Weese-Mayer, D.E., Auerbach, S.H. and Corwin, M.J. (2003) Symptoms of sleep-disordered breathing in 5-year-old children are associated with sleepiness and problem behaviors. Pediatrics, 112, 870-877.
 Schechter, M.S. (2001) Section on pediatrics pulmonology subcommittee obstructive sleep apnea syndrome. Technical report: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 109, e69. doi:10.1542/peds.109.4.e69
 Matsumoto, E., Tanaka, E., Tabe, H., Wakisaka, N., Nakata, Y., Ueda, H., Hori, T., Abe, T. and Tanne K. (2007) Sleep architecture and the apnea-hypopnea index in children with obstructive-sleep apnea syndrome. Journal of Oral Rehabilitation, 34, 112-120.
 Gozal, D. (1998) Sleep-disordered breathing and school performance in children. Pediatrics, 102, 616-620.
 Gozal, D. and Pope, D.W. (2001) Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics, 107, 1394-1399.
 Owens, J., Opipari, L., Nobile, C. and Spirito, A. (1998) Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders. Pediatrics, 102, 1178-1184. doi:10.1542/peds.102.5.1178
 Downey, R., Perkin, R.M. and MacQuarrie, J. (1993) Upper airway resistance syndrome: Sick, symptomatic but unrecognized. Sleep, 16, 620-623.
 Gislason, T. and Benediktsdottir, B. (1995) Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old: An epidemiologic study of lower limit of prevalence. Chest, 107, 963-966.
 Brunetti, L., Rana, S., Lospalluti, M.L., Pietrafesa, A., Francavilla, R., Fanelli, M. and Armenio, L. (2001) Prevalence of obstructive sleep apnea syndrome in a cohort of 1207 children of southern Italy. Chest, 120, 1930-1935. doi:10.1378/chest.120.6.1930
 Corbo, G.M., Fuciarelli, F. and Foresi, A. (1989) Snoring in children: Association with respiratory symptoms and passive smoking. British Medical Journal, 299, 1491- 1494. doi:10.1136/bmj.299.6714.1491
 Carrol, J.L., McColley, S.A., Marcus, C.L., Curtis, S. and Loughlin, G.M. (1995) Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest, 108, 610-618.
 Linder-Aronson, S. (1970) Adenoids: Their effect on mode of breathing and nasal airflow and their relationship to characteristic of the facial skeleton and the dentition. Acta Otolaryngologica Supplementum, 265, 1-132.
 Harvold, E.P., Vargervik, K. and Chierici, G. (1973) Primate experiments on oral sensation and dental malocclusions. American Journal of Orthodontics, 63, 494-508.
 Proffit, W.R. and Fields, H.W. (1993) The etiology of orthodontic problem. Contemporary Orthodontics, 2nd Edition, Mosby, St. Louis, 105-138.
 O’Leary, A. (1990) Stress, emotion, and human immune function. Psychological Bulletin, 108, 363-383.
 Goodwin, J.L., Babar, S.I., Kaemingk, K.L., Rosen, G.M., Morgan, W.J., Sherrill, D.L. and Quan, S.F. (2003) Symptoms related to sleep-disordered breathing in White and Hispanic children. The Tucson Children’s Assessment of Sleep Apnea Study Chest, 124, 196-203.
 Hanrahan, K., McCarthy, A.M., Kleiber, C., Lutgendorf, S. and Tsalikian, E. (2006) Strategies for salivary cortisol collection and analysis in research with children. Applied Nursing Research, 19, 95-101.
 Teculescu, D.B., Caillier, I. and Perrin, P. (1992) Snoring in French preschool children. Pediatric Pulmonology, 13, 239-244. doi:10.1002/ppul.1950130412
 Olsen, K. and Kern, E.B. (1995) Nasal influences on snoring and obstructive sleep apnea. Mayo Clinic Proceedings, 65, 1095-1105.
 Mestecky, J. (1993) Saliva as a manifestation of the common mucosal immune system. Annals of the New York Academy of Sciences, 694, 184-194.
 Frank, Y., Kravath, R., Pollak, C.P. and Weitzman, E.D. (1983) Obstructive sleep apnea and its therapy: Clinical and polysomnographic manifestations. Pediatrics, 71, 737-742.
 Brouillette, R.T., Fernbach, S.K. and Hunt, C.E. (1982) Obstructive sleep apnea in infants and children. Journal of Pediatric, 100, 31-40.
 Suter, P.M., Maire, R., Holtz, D. and Vetter, W. (1997) Relationship between self-perceived stress and blood pressure. Journal of Human Hypertension, 11, 171-176.
 Kirschbaum, C. and Hellhammer, D.H. (1994) Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology, 19, 313-333. doi:10.1016/0306-4530(94)90013-2
 Prussner, J.C., Wolf, O.T., Hellhammer, D.H., Buske- Kirschbaum, A., Von Auer, K., Jobst, S., Kaspers, D. and Kirschbaum, C. (1997) Free cortisol levels after awakening: A reliable biological marker for the assessment of adreno-cortical activity. Life Sciences, 61, 2539-2549.
 Yehuda, R., Halligan, S.L., Yang, R.K., Guo, L.S., Makotkine, I., Singh, B. and Pickholtz, D. (2003) Relationship between 24-hour urinary-free cortisol excretion and salivary cortisol levels sampled from awakening to bedtime in healthy subjects. Life Sciences, 73, 349-358.
 Yamada, T., Tanne, K., Miyamoto, K. and Yamauchi, K. (1997) Influences of nasal respiratory obstruction on craniofacial growth in young Macaca fuscata monkeys. American Journal of Orthodontics and Dentofacial Orthopedics, 111, 38-43.
 Miller, A.J., Vargervik, K. and Chierici, G. (1984) Experimentally induced neuromuscular changes during and after nasal airway obstruction. American Journal of Orthodontics, 85, 385-392.
 Bresolin, D., Sharpiro, P.A., Sharpiro, G.G., Chapko, M.K. and Dassel, S. (1983) Mouth breathing in allergic children: Its relationship to dentofacial development. American Journal of Orthodontics, 83, 334-343.