Evaluation of obesity and asthma as risk factors for moderate to severe obstructive sleep apnea in children

Iulia Ioan; Guillaume Mulier; Jessica Taytard; Audrey Césaire; Nicole Beydon

doi:10.5664/jcsm.9948

Evaluation of obesity and asthma as risk factors for moderate to severe obstructive sleep apnea in children

J Clin Sleep Med. 2022 Jun 1;18(6):1639-1648. doi: 10.5664/jcsm.9948.

Authors

Iulia Ioan^{1

2}, Guillaume Mulier³, Jessica Taytard^{4

5}, Audrey Césaire⁶, Nicole Beydon^{6

7}

Affiliations

¹ Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, CHRU de Nancy, France.
² DevAH, Université de Lorraine, Nancy, France.
³ Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, INSERM CIC 1426, F-75019 Paris, France.
⁴ Assistance Publique-Hôpitaux de Paris, Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Paris, France.
⁵ INSERM, UMRS1158, Sorbonne Université, Paris, France.
⁶ Assistance Publique-Hôpitaux de Paris, Unité Fonctionnelle de Physiologie - Explorations Fonctionnelles Respiratoires et du Sommeil, Hôpital Armand Trousseau, Paris, France.
⁷ INSERM, U 938, Centre de Recherche Saint Antoine, Hôpital Saint-Antoine, Paris, France.

Abstract

Study objectives: Asthma and obesity are risk factors for obstructive sleep apnea (OSA) in children but their link to OSA severity is uncertain. We aimed at determining whether asthma or obesity was associated with an increased risk of moderate/severe OSA.

Methods: Children undergoing a one-night polysomnography for suspicion of OSA were retrospectively included. Univariate and multivariate analyses were conducted to assess the clinical and demographic characteristics linked to moderate/severe OSA (obstructive apnea-hypopnea index ≥ 5 events/h of sleep) with odds ratio and 95% confidence interval reported.

Results: Four hundred ninety children (311 [64%] boys) were included with a median [25th; 75th percentile] age of 8.7 [5.4; 12.9] years, 164 (33%) nonasthmatics nonobese, 122 (25%) obese nonasthmatics, 125 (26%) asthmatics nonobese, 79 (16%) asthmatics and obese. Moderate/severe OSA was present in 157 (32%) children (75/157 [48%] obese and 52/157 [33%] asthmatics). Independent factors associated with increased or decreased risk of moderate/severe OSA were obesity and male sex (odds ratio 1.82 [1.16; 2.87], P = .01, and 1.55 [1.02; 2.36], P = .04, respectively), and current asthma, age > 6 years, or behavioral disorders (odds ratio 0.45 [0.29; 0.70], P < .001; 0.44 [0.27; 0.73], P < .001; and 0.55 [0.33; 0.92], P = .02, respectively). Abnormal resistance of the respiratory system (measured in 241 children), but not abnormal spirometry (measured in 213 children), increased the risk of moderate/severe OSA (odds ratio 2.95 [1.46-5.96], P = .003).

Conclusions: In our cohort enriched in obese and asthmatic children, obesity was associated with higher risk of moderate/severe OSA whereas current asthma was not.

Citation: Ioan I, Mulier G, Taytard J, Césaire A, Beydon N. Evaluation of obesity and asthma as risk factors for moderate to severe obstructive sleep apnea in children. J Clin Sleep Med. 2022;18(6):1639-1648.

Keywords: apnea index; asthma; children; obesity; polysomnography.

MeSH terms

Asthma* / complications
Asthma* / epidemiology
Child
Female
Humans
Male
Obesity / complications
Obesity / epidemiology
Retrospective Studies
Risk Factors
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / epidemiology