Abstract
Purpose
Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder affecting children. This study aims to characterize factors associated with the development and progression of severe forms of paediatric OSA.
Methods
This study included children admitted to Children’s Hospital of Chongqing Medical University, a tertiary children’s hospital in southwest China between January 2020 and December 2020 with a discharge diagnosis of OSA. Each patient underwent polysomnography examination, following assessments of apnoea-hypopnea index (AHI) and lowest oxygen saturation (LSaO2) by standardized techniques. Demographic and clinical information was collected from the hospital’s electronic medical records. Associations between OSA severity and various factors were first examined in a univariate logistic model, with subsequent multivariate analysis to further identify independent risk factors.
Results
A total of 263 children were identified during the study period. Among patients presenting with OSA, 51.3% had mild and 48.7% had moderate to severe symptoms according to standardized guidelines. The incidence of mild and moderate to severe hypoxemia in our population was 39.2% and 60.8%, respectively. Allergic rhinitis (AR; adjusted odds ratio (aOR) = 1.75, 95% CI 1.03–2.96) and male gender (aOR = 1.77, 95% CI 1.03–3.06) were significantly associated with moderate-to-severe OSA (all P-values < 0.05) after adjustment for covariates. AR was also the only significant predictor of hypoxemia (P < 0.05).
Conclusion
Our results suggest that male gender and presence of AR may be associated with an increased likelihood of moderate-to-severe OSA in children. These findings underscore the importance of timely intervention and individualized management for at-risk individuals.
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Data availability
The original data presented in the study are included in the article; further inquiries can be directed to the corresponding author.
Abbreviations
- AHI:
-
Apnoea-hypopnea index
- A/N:
-
Adenoidal-nasopharyngeal ratio
- aOR:
-
Adjusted odds ratio
- AR:
-
Allergic rhinitis
- ASA:
-
American Society of Anesthesiologists
- CHAT:
-
The Childhood Adenotonsillectomy study
- CysLT:
-
Cysteinyl leukotrienes
- ICD:
-
International Classification of Diseases
- IgE:
-
Immunoglobulin E
- LSaO2:
-
Lowest oxygen saturation
- OSA:
-
Obstructive sleep apnoea
- PSG:
-
Polysomnography
- SD:
-
Standard deviation
References
Editorial Board of Chinese Journal of Otorhinolaryngology Head-and Neck S, Chinese Otorhinolaryngology of Chinese Medical A. [Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome (Urumqi)] (2007) Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 42(2):83–84.
Li Z, Celestin J, Lockey RF. Pediatric sleep apnea syndrome: an update (2016). J Allergy Clin Immunol Pract. 4(5):852–61.
Magnusdottir S, Hill EA (2024) Prevalence of obstructive sleep apnea (OSA) among preschool aged children in the general population: a systematic review. Sleep Med Rev 73:101871
Li AM, So HK, Au CT, Ho C, Lau J, Ng SK, Abdullah VJ, Fok TF, Wing YK (2010) Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax 65(11):991–7
Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47(1):69–94
Hai Y, Kou W, Gu Z, Zhang C, Zou Q, Wang F, Yao H, Wei P (2023) Obstructive sleep apnea affects the psychological and behavioural development of children-a case-control study. J Sleep Res 33(1):e13924
Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R, Paruthi S, Muzumdar H, Gozal D, Thomas NH, Ware J, Beebe D, Snyder K, Elden L, Sprecher RC, Willging P, Jones D, Bent JP, Hoban T, Chervin RD, Ellenberg SS, Redline S. Childhood Adenotonsillectomy Trial (CHAT) (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 20;368(25):2366–76.
Working Group of Chinese Guideline for the Diagnosis and Treatment of Childhood OSA et al (2020) Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea. World J Otorhinolaryngol Head Neck Surg 7(3):201–220
Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM, Parikh SR, Shulman ST, Walner DL, Walsh SA, Nnacheta LC. (2019) Clinical practice guideline: tonsillectomy in children (update)-executive summary .Otolaryngol Head Neck Surg 160(2):187–205.
American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea (2014) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 120(2):268–286
Fujioka M, Young LW, Girdany BR (1979) Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol 133(3):401–404
Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. (2017) BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 47(7):856–889.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320(7244):1240–3
D’Elia C, Gozal D, Bruni O, Goudouris E, Meira E, Cruz M (2022) Allergic rhinitis and sleep disorders in children - coexistence and reciprocal interactions. J Pediatr (Rio J) 98(5):444–454
Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, Brignardello-Petersen R, Canonica GW, Casale T, Chavannes NH, Correia de Sousa J, Cruz AA, Cuello-Garcia CA, Demoly P, Dykewicz M, Etxeandia-Ikobaltzeta I, Florez ID, Fokkens W, Fonseca J, Hellings PW, Klimek L, Kowalski S, Kuna P, Laisaar KT, Larenas-Linnemann DE, LødrupCarlsen KC, Manning PJ, Meltzer E, Mullol J, Muraro A, O’Hehir R, Ohta K, Panzner P, Papadopoulos N, Park HS, Passalacqua G, Pawankar R, Price D, Riva JJ, Roldán Y, Ryan D, Sadeghirad B, Samolinski B, Schmid-Grendelmeier P, Sheikh A, Togias A, Valero A, Valiulis A, Valovirta E, Ventresca M, Wallace D, Waserman S, Wickman M, Wiercioch W, Yepes-Nuñez JJ, Zhang L, Zhang Y, Zidarn M, Zuberbier T, Schünemann HJ (2017) Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol 140(4):950–958
Zhang Y, Zhang L (2019) Increasing prevalence of allergic rhinitis in China Allergy Asthma. Immunol Res 11(2):156–169
Velasco E, Delicado-Miralles M, Hellings PW, Gallar J, Van Gerven L, Talavera K (2022) Epithelial and sensory mechanisms of nasal hyperreactivity. Allergy 77(5):1450–1463
Eckert DJ, Malhotra A (2008) Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5(2):144–53
Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS (2003) Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 22(5):827–32
Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C, Lee KY, Lee SH (2011) The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis. Eur Arch Otorhinolaryngol 268(4):533–9
Zheng M, Wang X, Zhang L (2018) Association between allergic and nonallergic rhinitis and obstructive sleep apnea. Curr Opin Allergy Clin Immunol 18(1):16–25
Walter LM, Tamanyan K, Nisbet L, Weichard AJ, Davey MJ, Nixon GM, Horne RSC (2019) Pollen levels on the day of polysomnography influence sleep disordered breathing severity in children with allergic rhinitis. Sleep Breath 23(2):651–657
Pateron B, Marianowski R, Monteyrol PJ, Couloigner V, Akkari M, Chalumeau F, Fayoux P, Leboulanger N, Franco P, Mondain M (2018) French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 135(4):265–8
Yu C, Wang K, Cui X, Lu L, Dong J, Wang M, Gao X (2020) Clinical efficacy and safety of omalizumab in the treatment of allergic rhinitis: a systematic review and meta-analysis of randomized clinical trials. Am J Rhinol Allergy 34(2):196–208
Park CE, Shin SY, Lee KH, Cho JS, Kim SW (2012) The effect of allergic rhinitis on the degree of stress, fatigue and quality of life in OSA patients. Eur Arch Otorhinolaryngol 269(9):2061–2064
Redline S, Kump K, Tishler PV, Browner I, Ferrette V (1994) Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 149(3 Pt 1):722–726
Su MS, Li AM, So HK, Au CT, Ho C, Wing YK. (2011) Nocturnal enuresis in children: prevalence, correlates, and relationship with obstructive sleep apnea. J Pediatr 159(2):238–242 e231.
Kljajić Z, Roje Ž, Bečić K, Čapkun V, Vilović K, Ivanišević P, Marušić E (2017) Formula for the prediction of apnea/hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: is it reliable? Int J Pediatr Otorhinolaryngol 100:168–173
Mitchell RB, Garetz S, Moore RH, Rosen CL, Marcus CL, Katz ES, Arens R, Chervin RD, Paruthi S, Amin R, Elden L, Ellenberg SS, Redline S (2015) The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) study randomized clinical trial. JAMA Otolaryngol Head Neck Surg 141(2):130–6
Kljajic Z, Glumac S, Deutsch JA, Lupi-Ferandin S, Dogas Z, Roje Z (2020) Feasibility study of determining a risk assessment model for obstructive sleep apnea in children based on local findings and clinical indicators. Int J Pediatr Otorhinolaryngol 135:110081
Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G (2013) Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol 62(7):569–576
Dayyat E, Kheirandish-Gozal L, Gozal D (2007) Childhood obstructive sleep apnea: one or two distinct disease entities? Sleep Med Clin 2(3):433–444
Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D (2008) Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 5(2):274–282
Funding
This study was supported by the National Natural Science Foundation of China (No. 82300031).
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YX conceptualized and designed the study. BY, QZ, and YX contributed to statistical analysis and interpretation and drafted the initial version of the manuscript. FW, PW, and YP were involved in study management and data collection. All authors provided substantial input into the revision of the manuscript and approved the final version of the submitted work.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Review Board of Children’s Hospital of Chongqing Medical University (No. 20220930–22). Informed consent was waived due to the retrospective nature of the study. All analyses in this study used anonymous clinical data.
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Yang, B., Zou, Q., Wang, F. et al. Allergic rhinitis as a predictor of moderate-to-severe paediatric obstructive sleep apnoea. Sleep Breath (2024). https://doi.org/10.1007/s11325-024-03011-6
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DOI: https://doi.org/10.1007/s11325-024-03011-6