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Published on: December 6, 2016
Comorbidities in infants with obstructive sleep apnea
William F Qubty1, Anna Mrelashvili1, Suresh Kotagal2
1Division of Child Neurology, Mayo Clinic, Rochester, MN.
Insights
Infants with obstructive sleep apnea (OSA) often have unique comorbidities like reflux and genetic syndromes, differing from older children. Early recognition and a multidisciplinary approach are key for effective infant OSA management.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Genetics
Background:
- Obstructive sleep apnea (OSA) in infants is not well-characterized.
- Identifying comorbidities can aid in earlier diagnosis and improved management of infant OSA.
Purpose of the Study:
- To describe common comorbidities in infants diagnosed with obstructive sleep apnea (OSA).
- To provide insights for earlier recognition and better management strategies for infant OSA.
Main Methods:
- Retrospective, single-center study of 139 infants (0-17 months) with OSA diagnosed via polysomnography (PSG).
- Exclusion criteria included >50% central apnea events.
- OSA severity classified using the apnea-hypopnea index (AHI).
Main Results:
- Gastroesophageal reflux (68%), periodic limb movements (42%), and craniofacial abnormalities (37%) were common comorbidities.
- OSA severity correlated with prematurity, genetic syndromes, and neuromuscular abnormalities.
- 86% of infants required multispecialty evaluations.
Conclusions:
- Infant OSA comorbidities differ from those in older children.
- Effective management necessitates a multidisciplinary approach involving genetics, gastroenterology, pulmonology, otolaryngology, neurology, and pediatrics.
Study Objective:
The clinical characteristics of obstructive sleep apnea (OSA) in infants have been insufficiently characterized. Our aim was to describe identifiable comorbidities in infants with obstructive sleep apnea, which may assist in recognizing these patients earlier in their disease course and help improve management.
Methods:
This was a single-center, retrospective study involving infants 0-17 months of age with a diagnosis of OSA on the basis of clinical features and nocturnal polysomnography (PSG) at the Mayo Clinic Center for Sleep Medicine between 2000 and 2011. Patients were excluded if they had central apnea accounting for greater than 50% of respiratory events. OSA severity was determined by the apnea-hypopnea index (AHI).
Results:
One hundred thirty-nine patients were included. Based upon the AHI, they were subdivided into mild (AHI <5; 30%), moderate (AHI 5-9; 30%), or severe (AHI >10; 40%) categories. Comorbidities included gastroesophageal reflux in 95/139 (68%), periodic limb movements in sleep in 59/139 (42%), craniofacial abnormalities in 52/139 (37%), neuromuscular abnormalities in 47/139 (34%), prematurity in 41/139 (29%), genetic syndromes in 41/139 (29%), laryngomalacia / tracheomalacia in 38/139 (27%), and epilepsy in 23/139 (17%) of subjects. Severity of OSA correlated with prematurity, having a genetic syndrome, or neuromuscular abnormality. Multispecialty evaluation was needed for 119/139 (86%).
Conclusion:
Comorbidities in infants with OSA differ from those of older children. Based upon the comorbidities identified in our study population, it appears that appropriate management of infants with OSA requires a multidisciplinary approach involving genetics, gastroenterology, pulmonology, otolaryngology, neurology, and general pediatrics.
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