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Association and risk factors of pediatric pulmonary hypertension with obstructive sleep apnea: A national study
Avraham Kohanzadeh1, Benjamin Wajsberg2, Elizabeth Yakubova3
1Albert Einstein College of Medicine, Bronx, NY, USA.
Insights
Pediatric pulmonary hypertension (PH) affects 0.21% of children, with obstructive sleep apnea (OSA) increasing risk over 10-fold. Obesity and other conditions also elevate PH risk in children.
Area of Science:
- Pediatric Cardiology
- Pulmonology
- Health Services Research
Background:
- Pediatric pulmonary hypertension (PH) is a serious condition with significant morbidity and mortality.
- Identifying risk factors is crucial for early detection and intervention in children.
- Obstructive sleep apnea (OSA) and obesity are increasingly recognized as potential contributors to pediatric PH.
Purpose of the Study:
- To determine the prevalence of pediatric PH in a large national dataset.
- To identify key risk factors associated with PH in children, with a focus on OSA and obesity.
- To analyze the association between OSA and PH prevalence in pediatric hospitalizations.
Main Methods:
- Retrospective cross-sectional cohort study using the 2016 Kids' Inpatient Database (KID).
- Analysis of 6,081,132 weighted pediatric discharges, examining demographics and comorbidities.
- Logistic regression models were used to identify risk factors for PH, including OSA and obesity.
Main Results:
- The overall prevalence of pediatric PH was 0.21%.
- Children with OSA had a 3.3% prevalence of PH, over 10 times higher than the general pediatric population.
- Significant risk factors for PH included OSA, central sleep apnea (CSA), obesity, congenital heart disease (CHD), and chronic lung disease of prematurity (CLDP).
Conclusions:
- OSA, CSA, obesity, asthma, and insurance status are independently associated with pediatric PH.
- Further multi-institutional studies are needed to elucidate causal links and guide screening protocols.
- Identifying children with OSA who may benefit from cardiopulmonary screening before adenotonsillectomy is essential.
Study Objective:
Assess the prevalence of and risk factors for pediatric pulmonary hypertension (PH) in the 2016 Kids' Inpatient Database (KID), including obstructive sleep apnea (OSA) and obesity.
Methods:
Retrospective cross-sectional cohort study utilizing 6,081,132 weighted pediatric discharges from the 2016 KID. Study variables included age, length of stay, mortality, gender, hospital region, primary payer, race, median household income for patient's ZIP code, OSA, central sleep apnea (CSA), obesity, Down syndrome, sickle cell disease (SCD), thalassemia, congenital heart disease (CHD), hypertension, asthma and chronic lung disease of prematurity (CLDP). PH was the primary outcome of interest. Bivariate and multivariable logistic regression models were utilized with odds ratios and 95 % confidence intervals.
Results:
The mean age was 3.76 years, the mean hospital length of stay was 3.85 days, 48.9 % were male, 52.6 % had government health insurance, 51.0 % were White, 16.1 % were Black, 21.1 % were Hispanic, 5.0 % were Asian or Pacific Islander, 0.80 % were Native American and 6.1 % identified as "other". The prevalence of PH was 0.21 % (12,777 patients). There were 37,631 patients with OSA and the prevalence of PH among this cohort was 3.3 %, over 10x greater than the overall prevalence of PH in the 2016 KID (0.21 %). Risk factors associated with PH included CLDP, CHD, Down syndrome, asthma, OSA, CSA, hypertension, SCD, obesity, race/ethnicity, government insurance, age, male gender (p < 0.0001), and hospital region (p = 0.0002).
Conclusions:
Several risk factors were independently associated with PH, such as OSA, CSA, obesity, asthma, and insurance status. Prospective multi-institutional studies are needed to assess the relationships between these risk factors, severity metrics, and causative links in the development of PH; in addition to identifying children with OSA who are most likely to benefit from cardiopulmonary screening prior to adenotonsillectomy.
Level Of Evidence:
Level III.
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