Monitoring air pollution effects on sleep-disordered breathing in children for supporting Public Health Policy

The so called “Sleep Disordered Breathing” (SDB) are breathing disorders which appear while the baby is sleeping. They rappresent a variety of pathologics mainly characterized by an airways change with snooring and/or a breathing effort caused by an increased resistance of the high airways and pharingeal collapse. Ethipatogenetic has been mainly understood and there are some risk factors like adenotonsillar hypertrophy, obesity and cranium-facial anomalies. There are also some other factors which can determine pathology like e.g. enviromental and genetic factors. In literature there are some studies that show how environmental pollution (outdoor and indoor) represents the main cause of SDB in a child. The aim of this ecological study is to analize the geografical distribution of SDB in the italian province of Varese, by using the data collected in the Pediatrics. In order to put in evidence the possible associations between SDB and the enriromental pollution, we have compared these results with NO2 distribution spatial scheme. NO2 can be considered the most important marker of enviromental pollution because it is the main component of gas emission and it’s correlated with other combustion products. Data were collected from 2010–2014 and focused on children who resided in Varese, were over 1 year of age, with SDB. The total number of children analyzed was 754: 476 males (63,13%) and 278 females (36,87%). Snooring occurs in 284 cases ((37,67%), mild OSAS in 259 (34,35%), moderate OSAS in 150 (19,89%) and severe OSAS in 61 (8,09%). For each patient, we gathered information about the child’s municipality of residence, sex, and the value of the apnea-hypopnea index (AHI). AHI is based on polysomnographic recordings conducted overnight by means of Embla’s Embletta Gold sleep system, a recording system that can discriminate the SDB severity level. All of the children were diagnosed with respect to SDB based on their AHI index. AHI mean is 3,48, value that doesn’t differ from the AHI in F and M (3,58 vs 3,42) With the available data was made a map representing the geography of the SDB. The results reported have to be considered preliminary and exploratory note abouve. The positive association we observed between SDB in children and the fact that they were living in an area characterized by a high density of traffic-related pollutants should be more carefully examined, as airway inflammation is a potential mechanism connected with the effect of air pollution and SDB exacerbations—such effect can be due to the oxidative stress related to the incomplete combustion of fossil fuels that produces high levels of polyaromatic hydrocarbons. Further research is necessary to clarify the role of air pollutants on SDB and on respiratory diseases in children. This additional work would allow the wider acquisition of knowledge about potentially modifiable contributors to the risk of developing SDB during childhood, which could then be the basis for improving children’s pulmonary health.