Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience
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.
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.
KeywordsAsthma Children Chronic cough Obstructive sleep apnea Protracted bacterial bronchitis
American College of Chest Physicians
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.
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.
Written informed consent was obtained from all individual participants’ parents included in the study. Additionally, participants above 8 years approved a pediatric informed consent.
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.
- 3.Berry RB, Brooks R, Gamaldo CE, for the American Academy of Sleep Medicine et al (2016) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.3. www.aasmnet.org. Darien, Illinois: American Academy of Sleep Medicine
- 8.Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM, Thoracic Society of Australia and New Zealand; Thoracic Society of Australia and New Zealand (2006) Cough in children: definitions and clinical evaluation. Med J Aust 184(8):398–403Google Scholar
- 9.Chang AB, Robertson CF, Van Asperen PP, Glasgow NJ, Mellis CM, Masters IB, Teoh L, Tjhung I, Morris PS, Petsky HL, Willis C, Landau LI (2012) A multicenter study on chronic cough in children: burden and etiologies based on a standardized management pathway. Chest 142(4):943–950. https://doi.org/10.1378/chest.11-2725 CrossRefGoogle Scholar
- 10.Chang AB, Robertson CF, van Asperen PP, Glasgow NJ, Masters IB, Teoh L, Mellis CM, Landau LI, Marchant JM, Morris PS (2013) A cough algorithm for chronic cough in children: a multicentre, randomized controlled study. Pediatrics 131(5):e1576–e1583. https://doi.org/10.1542/peds.2012-3318 CrossRefGoogle Scholar
- 12.Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K, Irwin RS, CHEST Expert Cough Panel (2017) Management of children with chronic wet cough and protracted bacterial bronchitis: CHEST Guideline and Expert Panel report. Chest 151(4):884–890. https://doi.org/10.1016/j.chest.2017.01.025 CrossRefGoogle Scholar
- 15.Galassi C, Forastiere F, Biggeri A, Gabellini C, De Sario M, Ciccone G, Biocca M, Bisanti L (2005) SIDRIA second phase: objectives, study design and methods. Epidemiol Prev 29(2 Suppl):9–13 [Article in Italian]Google Scholar
- 16.Gedik AH, Cakir E, Torun E, Demir AD, Kucukkoc M, Erenberk U, Uzuner S, Nursoy M, Ozkaya E, Aksoy F, Gokce S, Bahali K (2015) Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr 41:73. https://doi.org/10.1186/s13052-015-0180-0 CrossRefPubMedCentralGoogle Scholar
- 18.Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EL, Ersu R, Joosten K, Larramona H, MianS NI, Trang H, Tsaussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47(1):69–94CrossRefGoogle Scholar
- 22.Leconte S, Degryse J (2011) Prolonged cough in children in the primary care office. Rev Med Brux 32(1):5–9 [Article in French]Google Scholar
- 24.Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, Task Force ATS/ERS (2005) Standardisation of spirometry. Eur Resp J 26(2):319–338CrossRefGoogle Scholar
- 26.Shields MD, Bush A, Everard ML, McKenzie S, Primhak R, British Thoracic Society Cough Guideline Group (2008) BTS guidelines: recommendations for the assessment and management of cough in children. Thorax 63(Suppl 3):iii1–iii15Google Scholar
- 27.Singh D, Arora V, Sobti PC (2002) Chronic/recurrent cough in rural children in Ludhiana, Punjab. Indian Pediatr 39(1):23–29Google Scholar
- 28.Teoh L, Hurwitz M, Acworth JP, van Asperen P, Chang AB (2011) Treatment of obstructive sleep apnoea for chronic cough in children. Cochrane Database Syst Rev (4):CD008182. doi: https://doi.org/10.1002/14651858.CD008182.pub2