The impact of obstructive sleep apnea on bronchiolitis severity in children with Down syndrome

Po-Yang Tsou; Christopher M Cielo; Melissa S Xanthopoulos; Yu-Hsun Wang; Pei-Lun Kuo; Ignacio E Tapia

doi:10.1016/j.sleep.2021.04.004

The impact of obstructive sleep apnea on bronchiolitis severity in children with Down syndrome

Sleep Med. 2021 Jul:83:188-195. doi: 10.1016/j.sleep.2021.04.004. Epub 2021 Apr 16.

Authors

Po-Yang Tsou¹, Christopher M Cielo², Melissa S Xanthopoulos², Yu-Hsun Wang³, Pei-Lun Kuo⁴, Ignacio E Tapia⁵

Affiliations

¹ Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA; Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
² Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA.
⁴ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁵ Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: tapia@chop.edu.

Abstract

Objectives: Acute bronchiolitis commonly causes respiratory failure in children ≤2 years, and is particularly severe in those with Down syndrome (DS). Obstructive sleep apnea (OSA), common in DS, is also associated with respiratory complications. However, it is unknown whether OSA is associated with worse outcomes in children with and without DS, hospitalized with bronchiolitis. We hypothesized that in children with bronchiolitis, OSA is associated with worse outcomes in those with DS, independent of DS-related comorbidities.

Methods: Hospital discharge records of children with bronchiolitis aged ≤2 years were obtained for 1997-2012 from the Kid's Inpatient Database. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay, and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for DS-associated comorbidities.

Results: There were 928,961 hospitalizations for bronchiolitis. The DS group with bronchiolitis (n = 8697) was more likely to have OSA [241 (2.77%) vs 1293 (0.14%), p < 0.001] compared to the non-DS group (n = 920,264). Multivariable logistic regression showed that OSA was associated with IMV (adjusted odds ratio [OR], 3.32 [95% CI 2.54-4.35], p < 0.0001) in all children with bronchiolitis; and in those with DS, it was associated with IMV (adjusted OR, 2.34 [95% CI 1.38-3.97], p = 0.002), NIMV (adjusted OR, 8.21 [95% CI 4.48-15.04], p < 0.0001) and IACH (adjusted β, 0.18 [95% CI 0.02-0.34], p = 0.031).

Conclusions: OSA is independently associated with assisted ventilation in all children hospitalized with bronchiolitis, regardless of DS-associated comorbidities in those with DS. The severity of bronchiolitis in children with DS may be driven by the high prevalence of OSA.

Keywords: Bronchiolitis; Down syndrome; Hospitalization; Kids' inpatient database; Obstructive sleep apnea.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Bronchiolitis* / complications
Bronchiolitis* / epidemiology
Child
Comorbidity
Down Syndrome* / complications
Down Syndrome* / epidemiology
Humans
Odds Ratio
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / epidemiology

Abstract

Publication types

MeSH terms

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