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Secondhand Smoke exposure and risk of Obstructive Sleep Apnea in Children

Rajeev Subramanyam¹, Ignacio E Tapia¹, Bingqing Zhang¹

¹Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

International Journal of Pediatric Otorhinolaryngology

|December 10, 2019

Insights

Secondhand smoke (SHS) exposure is linked to more severe obstructive sleep apnea (OSA) in children. Children with severe OSA exposed to SHS had a 48% higher obstructive apnea hypopnea index (OAHI) than unexposed children.

Area of Science:

Pediatric Pulmonology
Sleep Medicine
Environmental Health

Background:

Obstructive sleep apnea (OSA) affects 4% of children, with limited research on secondhand smoke (SHS) impact.
Existing studies show conflicting results regarding SHS and OSA severity, often focusing on snoring.
This study investigates the association between SHS exposure and OSA severity in children aged 3-18.

Purpose of the Study:

To explore the relationship between secondhand smoke (SHS) exposure and obstructive sleep apnea (OSA) severity in children.
To determine if SHS exposure influences the obstructive apnea hypopnea index (OAHI) in pediatric patients.
To analyze SHS impact on OSA severity in a cohort of children aged 3-18 years.

Main Methods:

Retrospective, single-center study utilizing electronic medical records (EMR) from 2015-2018.
Data collected on SHS exposure via questionnaires and OSA severity measured by polysomnography (PSG) obstructive apnea hypopnea index (OAHI).
Analysis included all children and a subgroup with severe OSA (OAHI≥10/h), with multivariable adjustments.

Main Results:

Out of 101,884 queried records, 167 children aged 3-18 with reliable SHS and PSG data were analyzed.
Children with severe OSA exposed to SHS had a significantly higher median OAHI (29.0 vs. 19.5, p=0.04).
Multivariable analysis revealed SHS exposure increased OAHI by 48% in the severe OSA subgroup (p=0.01).

Conclusions:

Secondhand smoke (SHS) exposure is associated with increased obstructive sleep apnea (OSA) severity in children aged 3-18.
Children with severe OSA exposed to SHS demonstrated a 1.48-fold increase in the odds of a higher obstructive apnea hypopnea index (OAHI).
Study limitations include its retrospective nature and reliance on EMR data.

Read full analysis

Abstract

Objectives:

Obstructive sleep apnea (OSA) has a prevalence of 4% in children. Few studies have explored the role of secondhand smoke (SHS) on OSA severity and have shown contradicting results. Most studies have focused on the effect of SHS on snoring. This study explored the association of SHS exposure and OSA severity in children aged 3-18 years.

Methods:

This is a retrospective single center IRB-approved study. Electronic Medical Records (EMR) were queried between 1/24/2015 and 1/24/2018 to obtain data on SHS exposure with standard questionnaires from perioperative database. SHS was analyzed as a binary variable and OSA was measured using obstructive apnea hypopnea index (OAHI) from polysomnography (PSG) as a continuous variable. Analyses were done on all children and in those with severe OSA (OAHI≥10/h) as a subgroup.

Results:

EMR query yielded 101,884 children of whom 3776 had PSG. Limiting baseline PSG in 3-18-year-old and reliable information on SHS yielded 167 analyzable children of whom 70 had severe OSA. Children exposed to SHS had significantly more public insurance than non-exposed (p < 0.0001). Among children with severe OSA, median OAHI was significantly higher in SHS exposed compared to non-exposed (29.0vs.19.5,p = 0.04), but not across all children. In multivariable analysis SHS exposure increased OAHI by 48% in severe OSA subgroup (95%CI: 8%-102%; p = 0.01) when adjusted for race, body mass index, and adjusted household income.

Conclusion:

Children aged 3-18 years with severe OSA who were exposed to SHS were found to have 1.48 increase in odds of OAHI than those without SHS exposure. Results could be limited by retrospective nature of study and EMR tools.

Keywords:

Obstructive apnea hypopnea index Obstructive sleep apnea Polysomnography Secondhand smoke

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