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Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart

Daniel Combs1,2,3, Grant Skrepnek4, Michael D Seckeler5

  • 1Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, Arizona.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|September 5, 2018
PubMed

Insights

Sleep-disordered breathing (SDB) in infants with congenital heart disease (CHD) is linked to higher mortality, longer hospital stays, and increased costs. Central sleep apnea showed the most significant adverse outcomes in this vulnerable population.

Area of Science:

  • Pediatric Cardiology
  • Sleep Medicine
  • Healthcare Outcomes Research

Background:

  • Sleep-disordered breathing (SDB) is known to have adverse cardiovascular effects in adults.
  • The prevalence and impact of SDB in infants with congenital heart disease (CHD) remain understudied.
  • Existing research highlights SDB's association with increased mortality in adults with cardiac conditions.

Purpose of the Study:

  • To investigate the clinical and economic outcomes associated with SDB in hospitalized infants diagnosed with CHD in the United States.
  • To determine if SDB confers a similar increased mortality risk in infants with CHD as observed in adults.
  • To evaluate the impact of SDB on length of stay and total charges for infants with CHD.

Main Methods:

  • A retrospective, cross-sectional study utilizing the Kids' Inpatient Database (1997-2012).
  • Inclusion criteria: infants (<1 year) with diagnosed CHD. Exclusions: prematurity apnea, cardiac surgery, invasive ventilation.
  • Generalized linear models were employed to analyze mortality, length of stay, and total charges, controlling for covariates.

Main Results:

  • Among 461,778 infant CHD cases, 4,839 (1.0%) had SDB (14% obstructive, 4% central, 82% unspecified).
  • Central sleep apnea was significantly associated with increased inpatient mortality (OR 4.3), longer length of stay (+92%), and higher total charges (+112%) (P < .05).
  • Obstructive and unspecified SDB were also linked to longer stays and higher charges compared to infants without SDB (P < .001).

Conclusions:

  • Sleep-disordered breathing, especially central sleep apnea, is independently associated with adverse clinical and economic outcomes in hospitalized infants with CHD.
  • These findings underscore the importance of recognizing and managing SDB in this high-risk infant population.
  • Further research is warranted to explore the potential benefits of SDB treatment in mitigating adverse outcomes for infants with CHD.
Abstract

Keywords:
childrencongenital heart diseasesleep apneasleep-disordered breathing

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