Results
Data for a total of 325 patients with sleep problems who came to the OPD for help from April 2015 to May 2017 and underwent PSG were collected in our study. Among these patients, a total of 242 patients had problems of snoring, sleep apnea, and other sleep-related breathing disorders. Forty of the patients had involuntary limb movements during sleep. Twenty-seven of the patients had symptoms suggestive of parasomnias such as bruxism, enuresis, and sleep walking. Twenty-two patients had a history of excessive daytime sleepiness, and one had difficulty falling asleep.
A total of 310 of the children (209 males and 101 females aged from 5-17 years old, with a mean age of 8.5 years and median age of 10 years) had positive findings in the PSG and/or MSLT studies.
The final diagnoses in the 209 male patients were as follows: OSAS in 109 (52.2%), primary snoring in 57 (27.3%), PLMD in 19 (9.1%), idiopathic hypersomnia in 8 (3.8%), central apnea in 6 (2.9%), enuresis in 6 (2.9%), sleep terrors in 3 (1.4%), narcolepsy in 3 (1.4%), sleep seizures in 1 (0.5%), 1 bruxism in 1 (0.5%). There were 5 male children who were diagnosed with both OSAS and PLMD. In the 109 male children with OSAS, 80 had mild OSAS, 24 had moderate OSAS, and 5 had severe OSAS. Furthermore, 27 of them had asthma or allergic rhinitis, 5 had obesity, 2 had Duchenne muscular dystrophy, 1 had prematurity, and 1 had mucopolysaccharidosis (MPS) type 2. In the 19 male children with PLMD, 4 had underlying diseases: 2 had developmental delays, 1 had Tourette syndrome, and 1 had hydrocephalus. In the 6 male children with central apnea, 4 had congenital heart disease after operation, 1 had ganglioglioma post operation, and the other did not have any underlying diseases.
The final diagnoses in the 101 female patients were as follows: OSAS in 50 (49.5%), primary snoring in 24 (23.8%), limb movement sleep disorder in 13 (12.9%), idiopathic hypersomnia in 4 (4.0%), bruxism in 4 (4.0%), sleep terrors in 2 (2.0%), sleep seizures in 2 (2.0%), enuresis in 1 (1.0%), and sleep walking in 1 (1.0%). There were 2 female children who had both OSAS and PLMD. In 101 female children with OSAS, 66 had mild OSAS, 31 had moderate OSAS, and 4 had severe OSAS. Furthermore, 10 of them had allergic rhinitis, 2 had diabetes mellitus, 1 had Down syndrome, and 1 had Prader-Willi syndrome. In the 13 female children with PLMD, 4 had underlying diseases: 2 had a history of febrile convulsion, 1 had a history of syncope history, and 1 had cerebral palsy. In the 2 female children with central apnea, 1 of them had congenital heart disease after operation, and the other did not have any underlying diseases. All of the patients’ final diagnoses are shown in Table 1 .
The methods used to manage the 270 of the 310 total patients with positive findings (40 patients did not come back to the OPD for follow-up visits) were as follows: operation with adenoidectomy and tonsillectomy was suggested for 37 patients with moderate or severe OSAS, and 23 patients (15 males and 8 females) (23/37=62%, or 7.4% of all the children enrolled in this study) underwent the operation; continuous positive airway pressure (CPAP) was used in 2 patients with central apnea (0.6%); medical treatment was used in 190 patients (61.3%); and the remaining patients were only placed under observation (n=99, 31.9%) (Figure 1 ). For the 14 patients with moderate or severe OSAS who did not undergo an operation, a repeated PSG study 6-12 months later was suggested, but only 3 of them returned for follow-up visits, and their AHI results were decreased at those follow-ups.