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Obstructive sleep apnea and fractures in children and adolescents
Lisa B Matlen1, Daniel G Whitney2, Daniel Whibley3
1Department of Pediatrics and Sleep Disorders Centers, University of Michigan, Ann Arbor, Michigan.
Insights
Children with untreated sleep apnea have higher risks of lower extremity fractures. While sleep apnea treatment improved fracture risk in boys, findings for girls were less clear, suggesting potential sex-specific benefits of treatment.
Area of Science:
- Pediatric Orthopedics
- Sleep Medicine
- Epidemiology
Background:
- Sleep apnea is increasingly diagnosed in children.
- Extremity fractures are common injuries in pediatric populations.
- The relationship between sleep apnea and fracture risk in children is not well understood.
Purpose of the Study:
- To investigate the association between sleep apnea diagnosis and treatment with site-specific extremity fractures in children and adolescents.
- To examine potential sex differences in this association.
Main Methods:
- Cross-sectional analysis of large-scale pediatric claims data (2016-2018).
- Identification of children (2-18 years) with sleep apnea, treatments (CPAP, adenotonsillectomy), and fractures using ICD-10, CPT, and HCPCS codes.
- Sex-stratified analysis of associations between sleep apnea status, treatment, and fracture location.
Main Results:
- Among over 2.3 million children, 0.41% had sleep apnea, with ~61% receiving treatment.
- Girls with sleep apnea (treated/untreated) showed increased odds of lower extremity fractures.
- Boys without sleep apnea treatment had increased odds of lower extremity fractures; treated boys had reduced odds of upper extremity fractures.
Conclusions:
- Untreated sleep apnea is linked to higher lower extremity fracture odds in both sexes.
- Sleep apnea treatment may reduce lower extremity fracture risk in boys, but not girls.
- Further research is needed to clarify upper extremity fracture associations and causality.
Study Objectives:
To examine, among girls and boys, associations between site-specific extremity fracture and sleep apnea diagnosis or treatment.
Methods:
A cross-sectional analysis of claims data from 2016 to 2018 for children aged 2-18 years. Children with sleep apnea, continuous positive airway pressure, adenotonsillectomy, and fracture were identified using International Classification of Diseases, 10th Revision, Current Procedural Terminology, and Healthcare Common Procedure Coding System codes. We examined sex-stratified associations between site-specific fracture, sleep apnea, and sleep apnea treatment.
Results:
Among 2,327,104 children, 9,547 (0.41%) had sleep apnea and nearly 61% were treated. Girls with sleep apnea, treated or untreated, had increased odds of lower, but not upper, extremity fracture compared to those without sleep apnea (treated 1.56, 95% confidence interval 1.11, 2.21; untreated odds ratio 1.63, 95% confidence interval 1.09, 2.44). Only boys untreated for sleep apnea had increased odds of lower extremity fracture in comparison to those without a diagnosis of sleep apnea (odds ratio 1.65, 95% confidence interval 1.20, 2.27). Interestingly, boys treated for sleep apnea but not those untreated, in comparison to boys without sleep apnea, had different (reduced) odds of upper extremity fracture (odds ratio 0.74, 95% confidence interval 0.59, 0.95).
Conclusions:
These large datasets provide evidence that both boys and girls with untreated sleep apnea have higher odds of lower extremity fractures. However, treatment for sleep apnea was associated with improved odds of lower extremity fracture only in boys. Upper extremity data were less clear. These data are cross-sectional and cannot show causality, but they suggest that treatment for sleep apnea may lower risk for extremity fractures in boys.
Citation:
Matlen LB, Whitney DG, Whibley D, Jansen EC, Chervin RD, Dunietz GL. Obstructive sleep apnea and fractures in children and adolescents. J Clin Sleep Med. 2021;17(9):1853-1858.
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