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Racial Disparity in Residual Sleep Apnea After Adenotonsillectomy

Shannon D Fayson1, Aleda M Leis2, Susan L Garetz1

  • 1Department of Otolaryngology, Head & Neck Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Michigan, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|May 21, 2023
PubMed

Insights

Black children with mild-to-moderate sleep apnea have higher residual obstructive sleep apnea risk post-adenotonsillectomy, especially if nonobese. Obesity modifies this risk, with nonobese Black children facing significantly greater odds of residual sleep apnea.

Area of Science:

  • Pediatric Sleep Medicine
  • Otolaryngology
  • Health Disparities Research

Background:

  • Black children exhibit a higher incidence of residual obstructive sleep apnea (OSA) following adenotonsillectomy compared to non-Black children.
  • Understanding the factors contributing to this racial disparity in post-adenotonsillectomy OSA is crucial for targeted interventions.

Purpose of the Study:

  • To investigate the role of child-level and socioeconomic factors in the association between Black race and residual obstructive sleep apnea after adenotonsillectomy.
  • To identify potential mediators, confounders, or effect modifiers in this disparity.

Main Methods:

  • Secondary analysis of data from the Childhood Adenotonsillectomy Trial, including 224 children aged 5-9 with mild-to-moderate OSA.
  • Logistic regression and mediation analysis were employed to assess the association between race, various risk factors, and residual OSA 6 months post-surgery.

Main Results:

  • Black children had 2.7 times greater odds of residual OSA post-adenotonsillectomy, adjusted for baseline factors.
  • Obesity significantly modified this association; nonobese Black children showed a 4.9-fold increased likelihood of residual OSA compared to non-Black children.
  • No significant mediation was found for the tested child-level or socioeconomic factors.

Conclusions:

  • Obesity acts as a significant effect modifier in the relationship between Black race and residual OSA after adenotonsillectomy for mild-to-moderate cases.
  • The increased risk of residual OSA in Black children is primarily observed in the nonobese subgroup, highlighting the complex interplay of race and obesity.
Abstract

Keywords:
health disparitieshealth equitypediatric OSApublic policyracismsocial determinants of health

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