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Prevalence, Severity, and Associated Risk Factors of Obstructive Sleep Apnea in a Pediatric Aerodigestive Population
Sandhya Kalavacherla1,2, Tzyynong L Friesen2,3, Jeremy Landeo-Gutierrez4
1University of California San Diego School of Medicine, La Jolla, California, USA.
Insights
Obstructive sleep apnea (OSA) is common in pediatric aerodigestive patients. Females, older children, and those with genetic diagnoses are more likely to have moderate to severe OSA.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Aerodigestive Medicine
Background:
- Obstructive sleep apnea (OSA) is a prevalent condition in children.
- Aerodigestive clinics manage complex pediatric cases often associated with OSA.
- Characterizing OSA in this specific population is crucial for targeted management.
Purpose of the Study:
- To determine the prevalence and severity of obstructive sleep apnea (OSA) in children referred to an aerodigestive clinic.
- To identify factors associated with moderate to severe OSA in this pediatric cohort.
- To evaluate the relationship between medical complexity and OSA severity.
Main Methods:
- Retrospective cohort study of 234 children undergoing polysomnography (PSG) for OSA evaluation.
- Data collected included demographics, symptoms, respiratory characteristics, and medical complexity scores (MCS).
- Statistical analyses included Kruskal-Wallis, Fisher's exact tests, and logistic regression to identify factors associated with moderate/severe OSA.
Main Results:
- OSA was diagnosed in 92% of children who completed PSG.
- Prevalence of mild, moderate, and severe OSA was 45.3%, 26.7%, and 19.8%, respectively.
- Female sex, age >9 years, and genetic/syndromic diagnoses were associated with moderate/severe OSA; no association with MCS was found.
Conclusions:
- Obstructive sleep apnea (OSA) is highly prevalent in pediatric aerodigestive populations.
- Increased likelihood of moderate to severe OSA observed in females, older children, and those with genetic/syndromic diagnoses.
- Screening for OSA is recommended for all children evaluated at aerodigestive clinics.
Objectives:
To characterize obstructive sleep apnea (OSA) and its severity in a referred pediatric population undergoing polysomnography (PSG) evaluation at an aerodigestive clinic.
Study Design:
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.
Results:
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).
Conclusions:
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.
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