Obstructive Sleep Apnea and Sickle Cell Anemia

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Obstructive sleep apnea syndrome (OSAS) prevalence in children with sickle cell anemia is not well described. Although these children often experience nocturnal oxygen desaturation, it is unclear whether they are more likely to have OSAS.WHAT THIS STUDY ADDS: Children with sickle cell anemia have a high prevalence of OSAS with typical symptoms, beyond just nocturnal oxyhemoglobin desaturation. This study supports the need for increased efforts to screen for, diagnose, and treat OSAS in this vulnerable population. abstract OBJECTIVE: To ascertain the prevalence of and risk factors for obstructive sleep apnea syndrome (OSAS) in children with sickle cell anemia (SCA). METHODS:Cross-sectional baseline data were analyzed from the Sleep and Asthma Cohort Study, a multicenter prospective study designed to evaluate the contribution of sleep and breathing abnormalities to SCArelated morbidity in children ages 4 to 18 years, unselected for OSAS symptoms or asthma. Multivariable logistic regression assessed the relationships between OSAS status on the basis of overnight inlaboratory polysomnography and putative risk factors obtained from questionnaires and direct measurements. RESULTS:Participants included 243 children with a median age of 10 years; 50% were boys, 99% were of African heritage, and 95% were homozygous for b S hemoglobin. OSAS, defined by obstructive apnea hypopnea indices, was present in 100 (41%) or 25 (10%) children at cutpoints of $1 or $5, respectively. In univariate analyses, OSAS was associated with higher levels of habitual snoring, lower waking pulse oxygen saturation (SpO 2 ), reduced lung function, less caretaker education, and non-preterm birth. Lower sleep-related SpO 2 metrics were also associated with higher obstructive apnea hypopnea indices. In multivariable analyses, habitual snoring and lower waking SpO 2 remained risk factors for OSAS in children with SCA. CONCLUSIONS:The prevalence of OSAS in children with SCA is higher than in the general pediatric population. Habitual snoring and lower waking SpO 2 values, data easily obtained in routine care, were the strongest OSAS risk factors. Because OSAS is a treatable condition with adverse health outcomes, greater efforts are needed to screen, diagnose, and treat OSAS in this high-risk, vulnerable population.

Hemoglobinopathies and sleep – The road less traveled

“…Nonetheless, when detected, nocturnal oxygen desaturation should be viewed as a surrogate marker for a more severe disease, and those patients should be referred for more comprehensive evaluation. Nocturnal SpO 2 values also correlate with [25,36], as well as with a diagnosis of OSA [37], thus emphasizing the importance of evaluating daytime oxygen saturation during any routine clinic visit, and potentially performing a standardized exercise test designed for that specific purpose.…”

Neurologic and Head and Neck Manifestations of Sickle Cell Disease

“…This obstructive sleep apnea may play an important role in the previously described neurocognitive dysfunction seen in SCD patients. 26 Direct imaging and quantitative assessment of the lymphoid tissue is rarely performed; however, the findings of lymphoidal hypertrophy are frequently identifiable on routine imaging of the brain, spine, or neck (See Fig. 18).…”

Nocturnal Enuresis in Children and Adolescent with Sickle cell Anemia

“…SCA were retrieved after thorough literature search (Table 1A-1C) [4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. We categorized these articles in 3 groups according to the criteria used to define NE.…”

“…Group 3 (Table 1c): These are the studies that used different diagnostic criteria, they reported a prevalence rate of 32.2%-68.9% [4,[16][17][18][19][20][21][22][23][24][25].…”