Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea

Laryngoscope. 2021 Aug;131(8):1909-1914. doi: 10.1002/lary.29473. Epub 2021 Feb 25.

Abstract

Objective/hypothesis: Studies have suggested preterm birth, defined as gestational age (GA) <37 weeks, is a risk factor for obstructive sleep apnea (OSA) in later childhood. However, little is known about the characteristics, severity, and degree of intervention of childhood OSA in former preterm infants compared to term infants. This study compares polysomnographic characteristics and surgical interventions in former preterm and term infants presenting with sleep disordered breathing.

Study design: Retrospective cohort study from 2015 to 2019 at a single tertiary referral center.

Methods: Electronic Medical Records of pediatric patients ages 0 to 18 presenting with sleep disordered breathing were reviewed for gestational age, polysomnographic findings, clinical characteristics, and OSA surgical interventions. Association between gestational age, polysomnographic characteristics, and surgical interventions for OSA were reported.

Results: A total of 615 patient records were analyzed. Adjusting for covariates, prematurity was associated with a 2.97× higher likelihood of development of severe OSA (aOR (95%CI): 2.97 (1.40-6.32)), increased apneic-hypoxic index (AHI) (mean (SD): 6.5 (9.8) vs. 4.6 (6.4), P < .05), increased end tidal CO2 (50.5 (5.11) vs. 48.5 (5.8), P < .05), decreased REM latency (116 (64.7) vs. 132.4 (69.9), P < .05), and increased number of surgeries for OSA (0.65 (.95) vs. 0.45 (0.69), P < .05) compared to children born at term. Children born with GA < 32 weeks presented at a significantly later age with sleep disordered breathing (7.04 (.80) vs. 5.1 (0.15), P < .05) than children born at term.

Conclusions: Prematurity was associated with increased likelihood of severe OSA, increased AHI, as well as increased number of surgical interventions for OSA compared to children born at term. These results suggest an association with preterm birth and increased severity of childhood OSA.

Level of evidence: 3 Laryngoscope, 131:1909-1914, 2021.

Keywords: birthweight; management; obstructive sleep apnea; pediatric; prematurity; sleep disordered breathing.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / epidemiology*
  • Infant, Premature, Diseases / etiology
  • Male
  • Polysomnography
  • Prevalence
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index*
  • Sleep Apnea Syndromes / epidemiology*
  • Sleep Apnea Syndromes / etiology
  • Sleep Apnea, Obstructive / epidemiology*
  • Sleep Apnea, Obstructive / etiology
  • United States / epidemiology