Risk Factor Assessment Needed for Infants with Obstructive Sleep Apnea

Anuja Bandyopadhyay, MD

There remains a lot of unknown regarding why some infants develop obstructive sleep apnea (OSA), while others do not.

A team, led by Anuja Bandyopadhyay, MD, Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children’s Hospital, identified the demographics and comorbidities linked to obstructive sleep apnea in infants presenting with sleep related concerns to a tertiary care sleep.

Obstructive sleep apnea in infants is linked to changes in cognitive development, temperament, and behavior. However, the disorder can present with nonspecific symptoms in infants, making it important for researchers to gain a better understanding of which infants are at an increased risk of developing obstructive sleep apnea.

In the retrospective chart review planned for presentation at the American Thoracic Society (ATS) 2020 International Conference this year, the investigators examined all infants presenting to the sleep clinic with sleep-related issues between March 2016 and June 2017. The team collected demographic data, as well as sleep intake patient questionnaire results and diagnostic billing codes (ICD-10) for comorbidities and sleep diagnoses for each included infant.

The investigators then divided the cohort into patients with and without diagnosis of obstructive sleep apnea and compared combined demographics and prevalence of comorbidities in the 2 groups using continuous t-tests and categorical Chi Square models.

The unadjusted odds ratios was also calculated for significant demographics and comorbidities and logistic regression was performed to determine the link between obstructive sleep apnea and significant demographics and comorbidities (P <0.05).

Overall, the investigators evaluated 578 infants, 324 of which were diagnosed with obstructive sleep apnea. The infants with the disorder were decidedly younger and female (OR, 1.49; 95% CI, 1.043-2.145).

This patient group also had higher prevalence of bronchopulmonary dysplasia (OR, 1.56; 95% CI, 1.018-2.39), hypoxia (OR, 3.56; 95% CI, 2.35-5.4), craniofacial anomalies (OR, 2.35; 95% CI, 1.09-5.05), neuromuscular weakness (OR, 3.39; 95% CI, 1.47-7.79), pulmonary hypertension (OR, 2.11; 95% CI, 1.01-4.4), seizures (OR, 1.56; 95% CI, 1.06-2.3) reflux (OR, 2.53; 95% CI, 1.69-3.77), laryngomalacia (OR, 4.51; 95% CI, 2.82-7.27), and feeding dysfunction (OR, 3.08; 95% CI, 2.16-4.38).

In the multinomial logistic regression model, female gender (P = 0.006), hypoxia (P = 0.000), laryngomalacia (P = 0.000), trisomy 21(P = 0.049), and feeding dysfunction (P = 0.016) were significantly associated with a diagnosis of obstructive sleep apnea.

Infants with obstructive sleep apnea did not have a significantly higher prevalence of reported snoring or difficult breathing when compared to infants without obstructive sleep apnea.

Sleep apnea remains a major issue for adults, as untreated OSA doubles the hospital readmission risk for patients with chronic obstructive pulmonary disease (COPD).

In a review of US-based hospital admission data from May 2017 to July 2018, a team of investigators found worsened readmission and mortality rates among hospitalized COPD patients who screened positive for sleep apnea as well.

Of the 380 patients hospitalized for COPD exacerbations, 256 were screened for sleep apnea with a questionnaire. Almost all (n = 238) underwent overnight HRO/PM follow-up. Fewer than half (n = 111; 46.6%) were reported to have obstructive sleep apnea; 28.6% had a mild form, 9.7% moderate, and 8.4% severe

With sleep apnea emerging as a major problem in adults, the need for an earlier diagnosis is growing.

“To our knowledge, this is the first study describing an association between feeding dysfunction and infant OSA,” the authors wrote. “Future studies are needed to explore the relationship between these risk factors and infant OSA. This will help in early detection and timely management of infant OSA.”

The study, “Risk Factors for Obstructive Sleep Apnea in Infants,” was presented online during the ATS International Conference.