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Obstructive sleep apnea in 12 to 24 months old toddlers referred for sleep study in a tertiary care center
Egambaram Senthilvel1, Theresa Kluthe2, Quang L Nguyen3
1Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, Kentucky, KY 40241, USA. Egambaram.senthilvel@louisville.edu.
Insights
Obstructive sleep apnea (OSA) affects 68.5% of toddlers aged 12-24 months, with prematurity and Down syndrome increasing risk. Events predominantly occur during REM sleep, regardless of body position.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Neonatology
Background:
- Obstructive sleep apnea (OSA) is a significant health concern in toddlers.
- Understanding OSA prevalence and risk factors in this age group is crucial for early intervention.
Purpose of the Study:
- To determine OSA prevalence and associated comorbidities in toddlers aged 12-24 months.
- To investigate the impact of sleep stages and body positions on respiratory event distribution in pediatric OSA.
Main Methods:
- Retrospective analysis of overnight polysomnography (PSG) data from 283 toddlers (12-24 months).
- OSA severity classified using the obstructive apnea-hypopnea index (OAHI).
- Statistical analysis including multivariate regression to identify risk factors.
Main Results:
- OSA prevalence was 68.5%, with 39% severe cases.
- History of prematurity and Down syndrome were significant risk factors for OSA.
- Respiratory events were more frequent during REM sleep, with no significant positional effect.
Conclusions:
- Prematurity and Down syndrome are key risk factors for OSA in toddlers.
- REM sleep is a critical period for obstructive events in pediatric OSA.
- Findings highlight the need for targeted screening in high-risk infants.
Purpose:
To assess OSA prevalence, comorbidities, and the influence of sleep stages and body positions on respiratory events distribution in toddlers aged 12-24 months.
Methods:
A single center retrospective study that included toddlers aged 12-24 months old who underwent overnight PSG. OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1-4.9 events/h), moderate (5-9.9 events/h), and severe (≥ 10 events/h).
Results:
283 PSG data were included with a median age of 18 months (IQR 16-20.25) for the OSA group (168/283) and 19 months (IQR 16-22) for the non-OSA group (115/283) (p = 0.047). OSA prevalence was 68.5% (42.3% mild, 18.5% moderate, and 39% severe). 38.1% of children had no comorbidities, 24.4% had a history of prematurity and 11.3% had Down syndrome. Multivariate binominal regression analysis showed that children with history of prematurity (p = 0.017) and Down syndrome (p = 0.043) had higher odds of having OSA. The mean SaO2 in REM sleep was lower, and the mean time spent with oxygen saturation below 90% was higher in children with neuromuscular disease compared to those with other comorbidities. In toddlers without comorbidities, the median REM OAHI was 29.8 events/h (IQR: 58.48), whereas the median non-REM OAHI was 4.1 events/h (IQR: 10.4 p < 0.001). Supine OAHI was 7.9 (IQR: 24.9), and off supine OAHI was 10.5 (IQR: 18.1, p = 0.407).
Conclusion:
In toddlers aged 12-24 months, history of prematurity and Down syndrome were significantly associated with OSA. Obstructive respiratory events occurred predominantly in REM sleep, and no significant positional relations were noted.
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