Prevalence, Severity, and Associated Risk Factors of Obstructive Sleep Apnea in a Pediatric Aerodigestive Population

To characterize obstructive sleep apnea (OSA) and its severity in a referred pediatric population undergoing polysomnography (PSG) evaluation at an aerodigestive clinic.

We conducted a single institution, retrospective cohort study of 234 aerodigestive children who underwent diagnostic PSG for OSA over 5 years. Demographic, symptom, and respiratory characteristics were collected. Patients' medical complexity scores (MCS), a comorbidity burden metric on a scale of 0-7, were calculated via institution-specific criteria. Kruskal-Wallis rank sum and Fisher's exact tests compared sociodemographic and clinical characteristics by OSA severity. Logistic multivariable regression models identified factors associated with a moderate/severe OSA diagnosis.

A total of 86 children underwent diagnostic PSG. The median age at first study was 2 years; 53% were male, 27% Non-Hispanic White, and 49% Hispanic. OSA was diagnosed in 92% of those who completed a PSG, and the OSA severity was mild in 45.3%, moderate in 26.7%, and severe in 19.8%. Median MCS was 4 with no significant differences between OSA severity groups. Female sex (OR 2.51), age > 9 years (OR 3.22), and genetic/syndromic diagnoses (OR 2.44) were significantly associated with moderate/severe OSA. Multimodal treatments with pharmacologic therapy, respiratory support, and surgery were most effective in mitigating disease progression compared to single-modalities (p = 0.002).

OSA was highly prevalent in this pediatric aerodigestive cohort, with increased likelihood of moderate/severe disease in females, older children, and those with genetic/syndromic diagnoses. We observed no association between OSA severity and higher medical complexity. Consequently, OSA screening can be considered in all aerodigestive children.