Characteristics of obstructive sleep apnea in children with cerebral palsy: a comparative study with healthy children

Obstructive sleep apnea (OSA) can affect the growth and development of children, and serious OSA can lead to significant complications if left untreated. Children with cerebral palsy (CP) also experience sleep problems. Therefore, the present study examined the prevalence and differences of OSA in children with CP compared to healthy children. In addition, it sought to classify the children with CP according to different severities and clinical types in order to investigate whether there are differences in the severity of OSA and in sleep and respiratory characteristics among groups of children with different severities of CP.

One hundred and fifty-six children with CP and one hundred and fifty healthy children completed the Pediatric Sleep Questionnaire (PSQ). Based on the PSQ results, a threshold of 0.33 was used to define high risk of OSA. Children identified as high risk underwent polysomnography (PSG) to analyze their sleep structure, breathing events, oxygen saturation, and heart rate.

48.7% of children with CP and 26.67% of healthy children identified as high risk of OSA. The prevalence of OSA in children with CP (23.72%) was higher than that in healthy children (7.3%). Thus, children with CP have both a higher risk and a higher prevalence of OSA than healthy children, but the difference in the severity of OSA was not statistically significant.Also, there were no differences in OSA severity among groups of children with varying severities and types of CP. The proportion of rapid eyes movement (REM) sleep time, minimum transcutaneous oxygen saturation (SpO₂), and average SpO₂ during the sleep period was lower in children with CP than in healthy children. However, the N2 ratio, sleep latency (SL), OAI, OAHI and ODI were higher in children with CP as compared to healthy children. Additionally, the average and maximum heart rates during sleep were higher in children with CP than in healthy children. According to the severity of CP and clinical classification, children with severe CP exhibited a lower proportion of REM sleep time, a lower N3 ratio, reduced total sleep time (TST), decreased sleep efficiency (SE), and lower average SpO₂ during the sleep period compared to children with mild and moderate CP. However, they had a higher N2 ratio, increased OAI, elevated ODI, and a higher maximum heart rate during the sleep period compared to children with mild and moderate CP. Children with dyskinetic CP had a higher ODI index and N2 ratio than children with spastic CP.

Children with CP have a higher risk and prevalence of OSA than healthy children. Although there were no differences in OSA severity among groups of children with varying severities of CP, children with severe CP exhibited more severe sleep disturbances and breathing issues compared to children with mild and moderate CP.