Sleep, breathing, and cephalometrics in older children and young adults .1. Normative values

Study objectives: Aims were (1) to provide normative values for sleep and sleep-related breathing variables and physical features (cephalometrics, body mass index [BMI], and tonsillar size) in older children/adolescents and young adults, (2) to describe sex and age group differences, and (3) to evaluate relationships between physical features and sleep-related breathing variables. Design: Standard polysomnographic variables describing sleep and breathing were measured during a single night. Cephalometric measures were obtained from a standing lateral skull radiograph. Subjects: Normal, healthy boys (n=23; mean age= 13.3+/-2.1 years), girls (n=22; mean age=13.8+/-1.8 years), men (n=23; mean age=22.2+/-1.5 years), and women (n=24; mean age=22.4+/-1.8 years) with BMI less than 27 were evaluated. Results: Sleep variables showed age group and sex differences consistent with published norms, Slow-wave sleep and rapid eye movement (REM) latency declined with age; transient arousals increased with age. Sleep-related breathing variables showed few changes related to age group or sex: small but statistically significant sex differences were found for arterial oxygen saturation nadir (lower in male subjects) and respiration disturbance index in non-REM sleep (greater in male subjects). Differences in cephalometric measures largely reflected normal growth and expected sex differences. No significant relationships between sleep-related breathing variables and physical findings were observed. Conclusions: These data provide well-controlled normative values for sleep, breathing, and cephalometrics in a group of normal older children, adolescents, and young adults. The data provide useful reference points for patients of these ages in whom sleep apnea is suspected, particularly since such clinical studies are normally based on first-night polysomnography. Furthermore, these values represent developmentally appropriate grouping of the data.