Infancy Morbidity Associated with Sleep Apnea, Congenital Heart Disease

Daniel Combs, MD

While the hazards of sleep-disordered breathing (SDB) in adults with cardiac disease has been found to increase mortality risk, SDB’s mortality risk in infants with congenital heart disease (CHD) has remained unknown. But now University of Arizona investigators have found an association between a specific type of SDB, central sleep apnea, and an increased risk of mortality, suggesting SDB in infants with CHD poses a morbidity risk.

“We know that sleep apnea has negative effects on cardiovascular health in children and adults,” lead investigator, Daniel Combs, MD, told MD Magazine^Ò. “Additionally, adults with heart failure and sleep apnea are at increased risk for death. We focused on children with congenital heart disease who we thought would be at higher risk for negative cardiovascular consequences of sleep apnea.”

By utilizing data from the Kid’s Inpatient Database—a national database of pediatric discharge information including over 4100 US community hospitals—the team studied infants with CHD aged 1 year or younger with a diagnosis of sleep apnea.

Of the infants from the database with a heart abnormality and SBD, central sleep apnea was classified in 193 infants (4%), obstructive sleep apnea was classified in 679 patients (14%), and non-specified sleep apnea was classified in the remaining 4096 patients (82%), accounting for 4839 patients total.

In multivariable analyses, data revealed an association between central sleep apnea and an increased risk of inpatient mortality (odds ratio 4.3), 92% longer inpatient stay, and 112% higher total charges in comparison to CHD infants without comorbid SDB (P < .05).

Additionally, longer adjusted lengths of stay (56% and 18%, respectively) and higher charges (48% and 21%, respectively) were associated with obstructive and unspecified SDB—relative to infants with CHD without comorbid SDB (P < .001).

“In our retrospective study of hospital admissions across the US, we found that both central and obstructive sleep apnea are associated with longer hospital stays and higher hospital costs in infants with congenital heart disease,” Combs added. “In addition, we found that central sleep apnea was associated with a 4x increased risk of death in infants with congenital heart disease.”

In addition to the increased morbidity risk, the team also found infants with CHD and central sleep apnea stayed in hospitals twice as long, accumulating double the hospital bills at discharge.

To establish whether adverse patient outcomes can be repealed by treatment of SDB in infants with CHD, the team noted further research will need to be conducted.

Future research aside though, Combs emphasized the importance of screening as a preventative measure for negative outcomes in infants with central sleep apnea and CHD in a recent statement.

Since treatment can be referred for these patients, such as supplemental oxygen or positive airway pressure therapy, negative outcome can be improved.

“We have an ongoing prospective study evaluating how common sleep apnea is in children with congenital heart disease, and what negative effects it may have,” Combs concluded. “Additionally, our data suggest that the presence of central sleep apnea in hospitalized infants with congenital heart disease may signify an increased risk of death.”

Recognition of central sleep apnea by physicians in a hospital setting, he noted, may help identify infants at higher risk for death.

The study, "Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart Disease," was published online in the Journal of Clinical Sleep Medicine.