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Published on: December 6, 2016
Risk factors of obstructive sleep apnea syndrome in children
Zhifei Xu1, Yunxiao Wu2, Jun Tai3
1Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Insights
This study identified key risk factors for childhood obstructive sleep apnea (OSA). Snoring, male gender, obesity, breastfeeding, and enlarged tonsils/adenoids are significant predictors in children.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Public Health
Background:
- Childhood obstructive sleep apnea syndrome (OSAS) is linked to factors like obesity and enlarged tonsils/adenoids.
- The association of allergic rhinitis and environmental tobacco smoke with OSAS in children requires further investigation.
- This study aimed to identify OSAS risk factors in a diverse pediatric population.
Purpose of the Study:
- To determine the independent risk factors for obstructive sleep apnea syndrome (OSAS) in children.
- To analyze the association between various demographic, clinical, and environmental factors and OSAS.
- To provide insights for early identification and intervention strategies for pediatric OSAS.
Main Methods:
- Enrolled 1578 children aged 2-15 years with snoring symptoms undergoing polysomnography (PSG).
- Collected data via questionnaires, physical examinations (including BMI, neck circumference), and PSG.
- Defined OSAS based on an obstructive apnea-hypopnea index (OAHI) ≥ 1.
Main Results:
- Obesity, male gender, breastfeeding, tonsillar hypertrophy, adenoid hypertrophy, and snoring for ≥ 3 months were associated with OSAS.
- Multivariate analysis confirmed snoring duration, male gender, obesity, breastfeeding, tonsillar, and adenoid hypertrophy as independent risk factors.
- Socioeconomic factors require further exploration regarding the breastfeeding-OSAS relationship.
Conclusions:
- Snoring for ≥ 3 months, male gender, obesity, breastfeeding, tonsillar hypertrophy, and adenoid hypertrophy are independent risk factors for pediatric OSAS.
- These findings highlight crucial factors for screening and managing OSAS in children.
- The study was registered on ClinicalTrials.gov (NCT02447614).
Background:
The known risk factors of childhood OSAS include tonsillar and adenoidhypertrophy, obesity, craniofacial anomalies, neuromuscular disorders and African-American (AA) ancestry. Whether other factors such as allergic rhinitis (AR), premature, environmental tobacco smoking (ETS) are associated with OSAS are inconsistent in different studies. Our study enrolled children of a broad age range and included potential risk factors of OSAS derived from previous studies and our own experience. Our objective is to identify risk factors of OSAS in children in a clinical setting.
Methods:
Children between 2 and 15 years of age exhibiting snoring symptoms who visited the sleep center for polysomnography (PSG) were enrolled. All children completed a questionnaire, physical examination and PSG. The questionnaire included demographic data and information related to potential risk factors for sleep disorders. A physical examination included measurements of height, weight, neck circumference, waist and hip ratio, visual evaluation of the tonsils and the degree of adenoid obstruction. Children with obstructive apnea-hypopnea index (OAHI) ≥ 1 were defined as OSAS.
Results:
A total of 1578 children were enrolled and1009 children exhibited OSAS. Univariate analyses showed that snoring occurring for ≥ 3 months, male gender, preterm birth, breastfeeding, obesity, neck circumference ≥ 30 cm, waist/hip ratio ≥ 0.95, tonsillar hypertrophy, and adenoid hypertrophy were associated with OSAS. The proportion of low educational level was higher in parents who breastfed their babies than those who didn't. Multivariate analysis showed that snoring for ≥ 3 months, male gender, obesity, breastfeeding, tonsillar hypertrophy, and adenoid hypertrophy were associated with OSAS. Confounders such as socioeconomic status, parental occupation, and health-related behaviors should be explored further to investigate the relationship between breastfeeding and OSAS.
Conclusion:
The independent risk factors for OSAS in children included snoring ≥ 3 months, male gender, obesity, breastfeeding, tonsillar and adenoid hypertrophy. The study was registered on Clinical Trials government (NCT02447614). The name of the trial is "Follow-up Studies of Primary Snoring (PS) and Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in Chinese Children" and the URL is https://clinicaltrials.gov/.
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