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Obstructive sleep apnea in children aged 3 years and younger: Rate and risk factors
Sarah Selvadurai1, Giorge Voutsas1,2, Evan J Propst2,3
1Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario.
Insights
Obstructive sleep apnea (OSA) is common in young children, with over half diagnosed. Referral by an otolaryngologist indicates a higher risk of moderate-severe OSA, necessitating early screening.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Child Neurology
Background:
- Undiagnosed obstructive sleep apnea (OSA) in children can lead to neurobehavioral issues.
- Limited data exists on OSA prevalence and risk factors in children under 4 years old.
Purpose of the Study:
- To determine the rate of OSA in healthy children aged 1-3 years.
- To identify risk factors for OSA presence and severity in this age group.
Main Methods:
- Retrospective chart review of 113 healthy children (1-3 years old) who underwent polysomnography (PSG) between 2012 and 2017.
- Data collected included demographics, referral history, and PSG findings.
Main Results:
- 58% of children were diagnosed with OSA; 42% had no OSA.
- Nasal and tonsillar hypertrophy were more common in children with OSA.
- Referral by an otolaryngologist was associated with moderate-severe OSA (OR=2.6).
Conclusions:
- A significant rate of OSA exists in children aged 3 years and younger.
- Children referred by otolaryngologists are at higher risk for moderate-severe OSA.
- Early PSG and management are recommended for young children with OSA symptoms.
Objective:
Undiagnosed and untreated obstructive sleep apnea (OSA) can predispose children to neurobehavioural consequences. However, there is a lack of data identifying rate of, and risk factors for, OSA in very young healthy children. The objective of this study was to determine the rate of OSA and identify risk factors associated with the presence and severity of OSA in children aged 3 years and younger.
Methods:
This was a retrospective chart review of healthy children between 1 and 3 years old who had a baseline polysomnogram (PSG) between January 2012 and June 2017. Patient demographics, referral history, and PSG data were recorded.
Results:
One hundred and thirteen children were referred for a PSG, of which 66 (58%) were diagnosed with OSA and 47 (42%) did not have OSA. In the OSA group, 13 (20%) were mild and 53 (80%) were moderate-severe. Nasal congestion (P=0.001), adenoid hypertrophy (P=<0.001), and tonsillar hypertrophy (P=0.04) reported at the time of referral were more common in the OSA group compared to the no-OSA group. Binary logistic regression analysis showed that referral from an otolaryngologist (odds ratio=2.6, 95% confidence interval=1.1 to 6.0) were associated with moderate-severe OSA.
Conclusion:
A high rate of OSA was found among children aged 3 years and younger. Children referred by an otolaryngologist are more likely to be diagnosed with moderate-severe OSA. Children aged 3 years and younger with symptoms of OSA should be considered high-risk for OSA and be prioritized for early PSG and management.
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