European Journal of Pediatrics

, Volume 178, Issue 2, pp 189–197 | Cite as

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

  • Nisa Eda Cullas IlarslanEmail author
  • Fatih Gunay
  • Zehra Sule Haskologlu
  • Sevgi Kostel Bal
  • Zahide Ciler Tezcaner
  • Ceyda Tuna Kirsaclioglu
  • Selma Firat
  • Cansu Altuntas
  • Bulent Ciftci
  • Ozan Bagis Ozgursoy
  • Nazan Cobanoglu
Original Article


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.


Asthma Children Chronic cough Obstructive sleep apnea Protracted bacterial bronchitis 



American College of Chest Physicians


Apnea–hypopnea index


Flexible fiber-optic bronchoscopy


Gastroesophageal reflux disease




Obstructive sleep apnea


Obstructive sleep apnea syndrome


Persistent bacterial bronchitis


Pediatric cough specific quality of life




Pediatric sleep questionnaire


Upper airway cough syndrome



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.

Author 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.

Compliance with ethical standards

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.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nisa Eda Cullas Ilarslan
    • 1
    Email author
  • Fatih Gunay
    • 1
  • Zehra Sule Haskologlu
    • 2
  • Sevgi Kostel Bal
    • 2
  • Zahide Ciler Tezcaner
    • 3
  • Ceyda Tuna Kirsaclioglu
    • 4
  • Selma Firat
    • 5
  • Cansu Altuntas
    • 4
  • Bulent Ciftci
    • 6
  • Ozan Bagis Ozgursoy
    • 3
  • Nazan Cobanoglu
    • 7
  1. 1.Department of Pediatrics, Ankara University School of MedicineCebeci HospitalAnkaraTurkey
  2. 2.Department of Pediatric Allergy and Immunology, Ankara University School of MedicineCebeci HospitalAnkaraTurkey
  3. 3.Department of Otolaryngology-Head and Neck Surgery, Ankara University School of MedicineIbn-i Sina HospitalAnkaraTurkey
  4. 4.Department of Pediatric Hepatology and Nutrition, Ankara University School of MedicineCebeci HospitalAnkaraTurkey
  5. 5.Sleep Disorders CenterAtaturk Chest Diseases and Thoracic Surgery Training and Research HospitalAnkaraTurkey
  6. 6.Department of Chest DiseasesBozok University School of MedicineYozgatTurkey
  7. 7.Department of Pediatric Pulmonology, Ankara University School of MedicineCebeci HospitalAnkaraTurkey

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