Pediatric OSA: they might outgrow it

  • Chest

  • International Clinical Digest
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Takeaway

  • In this cohort study of children with obstructive sleep apnea (OSA), earlier diagnosis and more severe disease suggested a higher likelihood the condition would persist into adulthood. 
  • Authors urge pediatric obesity prevention, mitigation.

Why this matters

  • OSA affects 3%-5% of children; etiology is commonly adenotonsillar hypertrophy.
  • Few longitudinal data exist on natural history, and very few studies have followed children into adulthood.

Key results

  • Mean ages at baseline, follow-up: 9.8, 20.2 years, respectively.
  • Upon follow-up, among participants with baseline obstructive apnea-hypopnea index (OAHI) >1 event/hour: 
    • 30% (29/96) experienced complete remission, and 
    • 69% (66/96) had
  • Upon follow-up, among those with baseline OAHI ≥5 events/hour (moderate-to-severe disease), 57% (12/21) had persistent disease.
  • Diagnosis at age >10 years vs younger age predicted persistence into adulthood.
  • OSA remission at follow-up predicted by female sex.
  • Incident OSA at follow-up predicted by:
    • Male sex;
    • Higher baseline BMI z-score, or increase;
    • OAHI >0; and
    • Habitual snoring.

Study design

  • Prospective community-based cohort study (n=243).
  • For 10 years, authors followed children with OSA and unaffected controls, monitoring symptoms, growth, tonsil size, polysomnography.
  • Outcome: associations with adult OSA and remission.
  • Funding: Hong Kong Special Administrative Region.

Limitations

  • Potential selection bias.
  • Unclear what later clinical significance resolved pediatric OSA might have.