Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience

Abstract

Chronic cough in children may be due to a diverse range of etiologies. We aimed to evaluate children with chronic cough following a standardized cough algorithm and assess obstructive sleep apnea (OSA) as a possible etiology. In addition, cough resolution rates of two different treatment protocols in children with non-specific cough were compared. A total of 237 children referred for chronic cough were assessed and classified according to etiologies. Children with non-specific cough were assigned either in the early-arm (group-1, n = 13) or delayed arm (group-2, n = 23). The presence of OSA was evaluated using a pediatric sleep questionnaire, and polysomnography was handled in indicated patients. Asthma (n = 82) and protracted bacterial bronchitis (PBB) (n = 73) were the most frequent etiologies. Cough resolution was higher in group-1 (100%) compared with group-2 (50%) (absolute risk reduction (rr) = 43.48% [95% CI 21.38–65.58%]). Polysomnography revealed mild (n = 6), moderate (n = 7), or severe (n = 5) OSA in 18 children, with adenoid/adenotonsillary hypertrophy as the leading cause.

Conclusion: We recognized asthma and PBB as the most frequent causes of chronic cough in our cohort. Early treatment of patients with high parental anxiety might be beneficial. We also believe that further studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms.

What is known?
• Chronic cough in children may be due to a diverse range of etiologies, including serious respiratory disorders. Thus, its correct diagnosis and treatment are essential.
• Although a well-defined reason of chronic cough in adults, obstructive sleep apnea (OSA) has not been been evaluated so far in children with chronic cough.
What is new?
• We examined OSA for the first time as a possible cause of chronic cough in children and detected OSA with polysomnography in cases who scored high pediatric sleep questionnaire (PSQ) scores.
• We believe that studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms for children with chronic cough.

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Abbreviations

ACCP:

American College of Chest Physicians

AHI:

Apnea–hypopnea index

FFB:

Flexible fiber-optic bronchoscopy

GERD:

Gastroesophageal reflux disease

Ig:

Immunoglobulin

OSA:

Obstructive sleep apnea

OSAS:

Obstructive sleep apnea syndrome

PBB:

Persistent bacterial bronchitis

Pc-QOL:

Pediatric cough specific quality of life

PSG:

Polysomnography

PSQ:

Pediatric sleep questionnaire

UACS:

Upper airway cough syndrome

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Acknowledgements

We thank the children and their parents for participation in our study. We are also grateful to Prof. Atilla Halil Elhan for his help in our statistical analysis.

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Authors

Contributions

NC and NECI designed the study. NECI conducted and interpreted the statistical analysis and had the primary responsibility in the formation of the initial draft. All authors provided substantial contributions to the design of the work, or the acquisition, analysis, or interpretation of the data, revised the initial draft, approved the final manuscript, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Nisa Eda Cullas Ilarslan.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent was obtained from all individual participants’ parents included in the study. Additionally, participants above 8 years approved a pediatric informed consent.

Ethical approval

The study protocol was approved by the Ankara University School of Medicine Institutional Ethics Committee (Approval number: 19-800-15; Dec 2015). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Communicated by Peter de Winter

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Cite this article

Ilarslan, N.E.C., Gunay, F., Haskologlu, Z.S. et al. Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience. Eur J Pediatr 178, 189–197 (2019). https://doi.org/10.1007/s00431-018-3276-x

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Keywords

  • Asthma
  • Children
  • Chronic cough
  • Obstructive sleep apnea
  • Protracted bacterial bronchitis