Some children may experience complete resolution of obstructive sleep apnea as they transition to adulthood, but persistent disease is more likely in those with certain characteristics, according to data published in CHEST.
The researchers conducted a longitudinal analysis of a prospective community-based cohort that was established for an OSA prevalence study. The cohort, which was established between 2003 and 2005, included 619 children aged 6 to 13 years. Of these participants, 243 participants (59% boys) completed 10-year follow-up. Mean age was 9.8 years at baseline and 20.2 years at follow-up.
At baseline, the obstructive apnea-hypopnea index (OAHI), which counted the total number of apneas or hypopneas per hour, was used to characterize the disease. OSA was defined as OAHI of more than one event per hour; mild OSA was defined as OAHI of one to five events per hour; and moderate to severe OSA was defined as OAHI of five events or more per hour. Disease remission was defined as having an OAHI of fewer than one event per hour at follow-up.
Results showed that associations between baseline and follow-up log-transformed OAHI differed according to age (P for interaction = .04) but not Tanner stage (P = .43), with researchers only observing a significant positive association in children aged 10 years or older at baseline.
Additionally, at follow-up, 30% of children with mild OSA at baseline had complete remission; 69% of those with mild OSA at baseline had an OAHI of fewer than five events per hour; 57% of those with moderate to severe OSA at baseline had persistent disease; and 22% of all participants had OSA with an OAHI of five events or more per hour. Those who achieved complete remission were more likely to be girls.
When comparing participants with incident OSA at follow-up vs. OAHI of fewer than five events per hour at both baseline and follow-up, the researchers found that risk for incident OSA increased with male sex, higher baseline BMI z score, presence of any respiratory events at baseline, increase in BMI z score and the presence of habitual snoring at both baseline and follow-up or at follow-up only.
“These findings are useful for risk stratification, disease counseling and prioritization when we consider management strategies for children with OSA,” the researchers wrote.
For instance, they noted that these data emphasize that children and adolescents with OSA should be considered differently, highlighting the fact that adolescents with OSA are likely to also have OSA as adults.
“This observation is important when we consider treatment options and priorities for children with OSA,” the researchers wrote. “More aggressive treatment and disease monitoring may be necessary for those who are male, obese or with more severe disease.” – by Melissa Foster
Disclosures: This research project was supported by funding from the Research Grants Council of the Hong Kong Special Administrative Region, China. The authors report no relevant financial disclosures.