Socioeconomic inequalities in pediatric obstructive sleep apnea

Ji Woon Park; Mona M Hamoda; Fernanda R Almeida; Zitong Wang; David Wensley; Bassam Alalola; Mohammed Alsaloum; Yasue Tanaka; Nelly T Huynh; Annalijn I Conklin

doi:10.5664/jcsm.9494

Socioeconomic inequalities in pediatric obstructive sleep apnea

J Clin Sleep Med. 2022 Feb 1;18(2):637-645. doi: 10.5664/jcsm.9494.

Authors

Ji Woon Park^{1

2}, Mona M Hamoda¹, Fernanda R Almeida¹, Zitong Wang^{3

4}, David Wensley⁵, Bassam Alalola^{1

6

7}, Mohammed Alsaloum^{1

7

8}, Yasue Tanaka^{1

9}, Nelly T Huynh^{10

11}, Annalijn I Conklin^{3

12}

Affiliations

¹ Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
² Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.
³ Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Biostatistics, School of Global Public Health, New York University, New York, New York.
⁵ Division of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁶ Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
⁷ King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
⁸ Department of Restorative and Prosthetic Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
⁹ Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.
¹⁰ Faculty of Dental Medicine, Université de Montréal, Montreal, Quebec, Canada.
¹¹ Centre de Recherche, CHU Sainte-Justine, Montreal, Quebec, Canada.
¹² Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, St. Paul's Hospital, Vancouver, British Columbia, Canada.

Abstract

Study objectives: To examine the association between multiple measures of socioeconomic status (SES) and objectively measured obstructive sleep apnea (OSA) in a Canadian pediatric population.

Methods: This was a cross-sectional study of 188 children (4-17 years, mean age 9.3 ± 3.5 years) prospectively recruited from two hospital sleep clinics in Canada, using multivariable-adjusted linear and logistic regression of five measures of SES including parental education, income, social class, geographic location, and perceived SES based on the MacArthur Scale of Subjective Social Status, assessed in relation to four polysomnographic OSA variables including apnea-hypopnea index, apnea index, mean oxygen saturation level, and oxygen desaturation index.

Results: Overall, low household-level SES appeared to be associated with both frequency (apnea index ≥ 1 events/h) and severity (apnea-hypopnea index ≥ 5 events/h) of OSA in children, with maternal education showing the most consistent and significant associations. Specifically, children with mothers reporting less than high school education had nearly three times the odds of having OSA after controlling factors including body mass index (odds ratio 2.96 [95% confidence interval, 1.05-8.37]), compared to university-educated participants. Consistent associations were also observed for geographic location with less frequency and severity of OSA among nonurban children. Perceived SES was minimally inversely associated with our outcomes.

Conclusions: This cross-sectional, multicenter study demonstrated that SES factors are linked to the occurrence and severity of OSA in children. Results indicated the need to incorporate the screening of SES in the diagnostic process of pediatric OSA to provide more targeted intervention and patient-centered care.

Citation: Park JW, Hamoda MM, Almeida FR, et al. Socioeconomic inequalities in pediatric obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):637-645.

Keywords: obstructive sleep apnea; pediatric; polysomnography; socioeconomic status.

Publication types

Multicenter Study

MeSH terms

Canada / epidemiology
Child
Child, Preschool
Cross-Sectional Studies
Humans
Polysomnography
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / diagnosis
Sleep Apnea, Obstructive* / epidemiology
Socioeconomic Factors