0722 Predictors of Severe Obstructive Sleep Apnea in Infants. (12th April 2019)

• Record Type: Journal Article
• Authors: Kombathula, Rachana; Williams, David D; Ingram, David G; Al-Shawwa, Bahauddin; Goldman, Robin; Ehsan, Zarmina
• Is Part Of: Sleep. Volume 42(2019)Supplement 1
• Page Start: A290
• Page End: A290
• Publication Date: 2019-04-12
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz067.720
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Currently there are no standardized guidelines for diagnosis and management of obstructive sleep apnea (OSA) in infants. Symptoms and disease pathophysiology differ from older children and are poorly understood. Herein we attempt to characterize clinical and polysomnographic predictors of severe OSA in infants. Methods: A retrospective, 5-year, single-institution, study of all infants aged ≤ 12 months who underwent a diagnostic polysomnogram (PSG). Infants were categorized into two groups: severe OSA and no OSA based on their obstructive apnea-hypopnea-index (AHIo). Severe OSA infants had AHIo≥10 and no OSA infants had AHIo≤1. PSG parameters, clinical, and demographic variables were evaluated. To determine statistical significance (two-sided, p≤0.05), two-sample Wilcoxon rank-sum (Mann-Whitney) or t-tests (with equal variances) were used for continuous variables and chi-square or Fisher's exact tests were used for categorical variables. Results: Forty-nine infants were included (28 severe OSA, 21 no OSA) with mean age (SD): 6 ± 3 months. There were significant differences in AHIo [median (IQR): 13.8 (11.6, 17.4) vs. 0.6 (0.4, 0.8); p<0.0001], oxygen saturations [median (IQR): 96% (95%, 97%) vs. 98% (97%, 98%); p<0.0001], central AHI [median (IQR): 2.4 (1.0, 5.9) vs. 1.1 (0.6, 1.8); p=0.0053], time spent with SpO2≤90% [median (IQR): 0.5 (0.2, 1.8) vs. 0 (0, 0); p<0.0001], percent of REM sleep [mean±SD: 30±9 vs. 24±8; p=0.0236], and age in months [(mean±SD): 5±3 vs. 8±3; p=0.0065] between severe OSA and no OSA infants respectively. There were no statistically significant differences in sex (64% male vs. 57%; p=0.612), race (75% white vs. 57% non-white; p=0.187), history of prematurity (29% vs. 10%; p=0.155), history of brief resolved unexplained event (7% vs. 19%; p=0.381), failure to thrive (29% vs. 10%; p=0.155), presence of a cleft palate (25% vs. 5%; p=0.115), adenotonsillar enlargement (39% vs. 19%; p=0.210), larygomalacia (21% vs. 33%; p=0.350), micrognathia (21% vs. 5%; p=0.214) in severe OSA vs. no OSA infants. Conclusion: Risk factors for severe OSA in infants remain poorly understood. These clinical factors, although not statistically different, may be of clinical relevance. Further research is needed to better understand the pathophysiology of infant OSA. Support (If Any): Department of Pulmonary and Sleep Medicine.