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The burden of obstructive sleep apnea in pediatric sickle cell disease: a Kids' inpatient database study

Po-Yang Tsou1,2, Christopher M Cielo2,3, Melissa S Xanthopoulos3

  • 1Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX.

Sleep
|August 25, 2020
PubMed

Insights

Obstructive sleep apnea (OSA) is linked to a 50% increased risk of neurologic complications (NC) in children with sickle cell disease (SCD). Noninvasive mechanical ventilation may alter this association.

Area of Science:

  • Pediatric Hematology
  • Sleep Medicine
  • Neurology

Background:

  • Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular and cerebrovascular diseases.
  • Patients with sickle cell disease (SCD) have a higher predisposition to both neurologic complications (NC) and OSA.
  • The interplay between OSA and SCD-related complications remains incompletely understood.

Purpose of the Study:

  • To investigate the association between obstructive sleep apnea (OSA) diagnosis and the occurrence of neurologic complications (NC) in pediatric patients with sickle cell disease (SCD).
  • To explore secondary outcomes including acute chest syndrome (ACS), vaso-occlusive crisis, and hospitalization costs in SCD patients with OSA.
  • To determine the potential modifying role of noninvasive mechanical ventilation (NIMV) in the relationship between OSA and NC in SCD.

Main Methods:

  • Utilized data from the Kid's Inpatient Database (1997-2012) for patients under 19 with SCD.
  • Defined primary outcome (NC) as a composite of stroke, transient ischemic attack, and seizures.
  • Employed multivariable logistic regression, adjusting for NIMV, to analyze the association of OSA with NC and other SCD complications.

Main Results:

  • Analysis included 203,705 SCD discharges; 1.4% had OSA and 2.2% had NC.
  • OSA was significantly associated with increased odds of NC (aOR, 1.50) and ACS (aOR, 1.34) in children with SCD.
  • After adjusting for NIMV, the association between OSA and NC was no longer statistically significant (aOR, 1.39).

Conclusions:

  • Obstructive sleep apnea (OSA) is associated with a 50% increased odds of neurologic complications (NC) in children with sickle cell disease (SCD).
  • The use of noninvasive mechanical ventilation (NIMV) for OSA treatment may influence the risk of OSA-associated NC in this population.
  • Further research is warranted to elucidate the mechanisms and clinical implications of OSA in pediatric SCD.
Abstract

Keywords:
Kids’ inpatient databasehospitalizationneurologic complicationsobstructive sleep apneasickle cell disease

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