Prevalence and Risk Factors of Sleep Disordered Breathing in School-Aged Children with Bronchopulmonary Dysplasia

Introduction:Sleep-disordered breathing (SDB) affects 1-5% of children, causing neurocognitive impairment, behavioral problems, and cardiovascular complications. Children with bronchopulmonary dysplasia (BPD) may have heightened SDB risk due to chronic lung disease, but prevalence and risk factors remain poorly characterized. This study describes SDB prevalence and evaluates associations with health factors (asthma, rhinitis, second-hand smoke exposure, overweight/obesity), neonatal history, and oropharyngeal crowding among school-age children (6-12 years) with BPD.Materials and Methods:Cross-sectional analyses were performed on children enrolled in the Indoor Air Quality and Respiratory Morbidity in School-Aged Children with BPD (AERO-BPD) study. Elevated SDB risk and symptom burden were defined by a Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD) total or subscale (snoring, sleepiness, hyperactivity) scores >0.33. Using logistic regression, we calculated associations between risk factors and elevated PSQ-SRBD scores.Results:Among 142 children (18% Hispanic, 14% Black or African American, 52% White or Caucasian, 14% Other), 34% had elevated PSQ-SRBD scores. Asthma was associated with 4-fold higher odds for SDB and 6-fold higher odds for snoring symptoms, odds ratio (OR): 3.75 (95% CI: 1.33, 10.58) and 6.22 (1.13, 34.36), respectively. Female gender and overweight/obese status increased odds of elevated snoring symptoms, whereas higher gestational reduced odds of snoring symptoms. Hispanic ethnicity was associated with increased sleepiness symptoms.Discussion:SDB is highly prevalent (34%) in school-aged children with BPD and associated with multiple modifiable health factors, particularly asthma. Providers should routinely screen children with BPD for SDB. Future research in larger samples is needed to characterize SDB mechanisms in children to develop targeted interventions.Contributions to Literature:This study provides comprehensive characterization of SDB prevalence and risk factors in school-aged children with BPD, identifying asthma as a key modifiable risk factor and establishing the foundation for screening guidelines in this vulnerable population.