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The impact of obstructive sleep apnea on bronchiolitis severity in children with Down syndrome

Po-Yang Tsou1, Christopher M Cielo2, Melissa S Xanthopoulos2

  • 1Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA; Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Sleep Medicine
|May 22, 2021
PubMed

Insights

Obstructive sleep apnea (OSA) is linked to increased need for respiratory support in children hospitalized with bronchiolitis. This association is independent of Down syndrome (DS) and its comorbidities, suggesting OSA significantly impacts bronchiolitis severity.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Genetics

Background:

  • Acute bronchiolitis is a common cause of respiratory failure in young children.
  • Children with Down syndrome (DS) experience more severe bronchiolitis.
  • Obstructive sleep apnea (OSA), prevalent in DS, is linked to respiratory complications.

Purpose of the Study:

  • To investigate the association between OSA and outcomes in hospitalized children with bronchiolitis.
  • To determine if OSA worsens outcomes in children with DS, independent of DS-related comorbidities.

Main Methods:

  • Analysis of hospital discharge records for children aged ≤2 years with bronchiolitis (1997-2012).
  • Primary outcome: invasive mechanical ventilation (IMV). Secondary outcomes: non-invasive mechanical ventilation (NIMV), length of stay, and hospitalization cost.
  • Multivariable regression models were used to assess associations, controlling for DS-related comorbidities.

Main Results:

  • OSA was significantly more common in children with DS hospitalized for bronchiolitis (2.77% vs 0.14%).
  • OSA was independently associated with IMV in all children with bronchiolitis (aOR, 3.32).
  • In children with DS, OSA was associated with IMV (aOR, 2.34), NIMV (aOR, 8.21), and increased hospitalization costs (β, 0.18).

Conclusions:

  • Obstructive sleep apnea is independently associated with the need for assisted ventilation in children hospitalized with bronchiolitis.
  • The high prevalence of OSA may contribute to the severity of bronchiolitis in children with Down syndrome.
  • Findings highlight the importance of considering OSA in managing bronchiolitis, particularly in children with DS.
Abstract

Keywords:
BronchiolitisDown syndromeHospitalizationKids' inpatient databaseObstructive sleep apnea

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