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The association of obstructive sleep apnea and behavioral insomnia in children ages 10 and under

Leila Yelov^1,2, Joel Reiter^1,3, Miguel Meira E Cruz^4,5

¹Faculty of Medicine, The Hebrew University, Jerusalem, Israel.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine

|September 29, 2023

Insights

This study found no association between behavioral insomnia of childhood (BIC) and obstructive sleep apnea (OSA) in children under 10. Healthcare providers should evaluate these sleep disorders separately due to distinct treatments.

Area of Science:

Pediatric Sleep Medicine
Sleep Disorders in Children

Background:

Behavioral insomnia of childhood (BIC) and obstructive sleep apnea (OSA) are common in children.
While studies in adults suggest a link between these conditions, their association in pediatric populations remains under-investigated.

Purpose of the Study:

To investigate the association between BIC and OSA in children aged 6 months to 10 years.
To determine if these two prevalent pediatric sleep disorders co-occur.

Main Methods:

Retrospective analysis of 312 children (6 months–10 years) referred for sleep evaluation.
Diagnosis of BIC based on ICSD-3 criteria; OSA diagnosed via polysomnography (apnea-hypopnea index > 2 events/h).
Exclusion criteria included chromosomal abnormalities, craniofacial issues, post-tonsillectomy status, and neurological impairment.

Main Results:

No significant association was found between BIC and OSA prevalence in the study cohort.
Children with comorbid insomnia and OSA were significantly younger (2.22 ± 1.21 years).
Younger age, premature birth, and increased periodic leg movements were linked to OSA; lower BMI was associated with BIC.

Conclusions:

The study does not support an association between BIC and OSA in young children.
Distinct diagnostic and therapeutic approaches are necessary for BIC and OSA.
Clinicians should consider both conditions independently in children with sleep complaints.

Read full analysis

Abstract

Study Objectives:

Behavioral insomnia of childhood (BIC) and obstructive sleep apnea (OSA) are highly prevalent conditions affecting 10%-20% and 1%-5% of children, respectively. Studies in adults and adolescents have suggested that comorbid insomnia and OSA may have distinct clinical characteristics. The association between the two conditions in the pediatric population has not been thoroughly investigated. This study aimed to examine the association between BIC and OSA in young children.

Methods:

Children, 6 months to 10 years old, referred to a sleep specialist and polysomnography at the Hadassah Medical Center between 2018 and 2021 were included in this retrospective analysis. We excluded children with chromosomal and craniofacial abnormalities, posttonsillectomy, or neurological impairment. BIC diagnosis was extracted from the electronic health records in accordance with the International Classification of Sleep Disorders, third edition criteria. OSA was diagnosed by polysomnography (apnea-hypopnea index > 2 events/h).

Results:

Of 312 children (age 4.42 ± 2.42 years), 126 (40.4%) were non-OSA non-BIC, 125 (40.1%) OSA non-BIC, 34 (10.9%) BIC non-OSA, and 27 (8.7%) comorbid insomnia and OSA. OSA and non-OSA children had a similar prevalence of BIC. Children in the comorbid insomnia and OSA group were significantly younger (2.22 ± 1.21 years). Younger age at polysomnography, premature birth, and increased periodic leg movements on polysomnography were independently associated with OSA in a multivariable analysis. Lower body mass index, regardless of OSA, was associated with BIC.

Conclusions:

Current findings do not support an association between behavioral insomnia of childhood and obstructive sleep apnea in children. Healthcare providers should consider each of these sleep disorders in children presenting with sleep difficulties since each has distinct diagnostic and therapeutic options.

Citation:

Yelov L, Reiter J, Meira E Cruz M, Gileles-Hillel A. The association of obstructive sleep apnea and behavioral insomnia in children ages 10 and under. J Clin Sleep Med. 2024;20(2):245-251.

Keywords:

children insomnia obstructive sleep apnea polysomnography

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