Prematurity as a Risk Factor of Sleep-Disordered Breathing in Children Younger Than Two Years: A Retrospective Case-Control Study

Abstract

Study Objectives: Sleep-disordered breathing (SDB) is a highly prevalent condition affecting 2% to 4% of children. However, the prevalence and characteristics of SDB in children younger than 2 years and the effect of prematurity as a risk factor remains unclear. Methods: Children younger than 24 months referred for PSG at two medical centers between the years 2014 to 2018 were included in this retrospective analysis. We excluded children with genetic syndromes. Polysomnography (PSG) was performed and scored according to American Academy of Sleep Medicine guidelines. Results: Ninety-eight children were included (age 14.1 ± 6.4 [2-23] months), with 31 born prematurely (PRETERM; 24 to 34 weeks gestational age). PRETERM had increased odds of SDB (age and sex adjusted), using a cutoff of AHI ≥ 5 events/h with an odds ratio of 4.3 (95% confidence interval 1.5-12.9). Gestational age was the only significant predictor for SDB in this cohort, every additional week of gestation reducing the odds of SDB by 12.5%. PRETERM SDB was also characterized by more severe nocturnal hypoxemia, increased frequency of central apnea, and altered sleep architecture. Conclusions: Current findings underscore the importance of prematurity antecedents as a risk factor for SDB in young symptomatic children younger than 2 years referred for a PSG. Future studies focused on improved estimates of the prevalence of SDB among nonreferral young children appear warranted.

Sleep disorders in children with asthma

“…Furthermore, both are relatively common and share several risk factors, which could act as confounders and are difficult to disentangle. Examples include a history of prematurity, considered a risk factor for asthma as well as SRBD and poor sleep [75][76][77] ; obesity, which serves as a clear risk factor for both and has been associated with short sleep duration 62,75,78 ; low socioeconomic status 79,80 ; and race. 80,81 Furthermore, though this review attempts to describe the association between asthma and the different sleep disorders, it is important to note that these disorders may overlap.…”

Preoperative optimization in the pediatric patient

“…In addition, prematurity is associated with sleep-disordered breathing (SDB). Sadras et al 47 examined the association of SDB with prematurity in a cohort of infants and toddlers and found a 4-fold increase in risk of SDB in children born premature when compared with their term-born peers. When addressing prematurity alone, optimization of the perioperative setting is vital.…”

Topic Sessions

“…Sadras et al (6) questioned whether prematurity is a risk factor for having moderate/severe sleep‐disordered breathing (SDB) (apnea/hypopnea index > 5 events/hour) before two years of age. They assessed 98 children aged 14 ± 6.4 months (range 2‐23), including 31 born between 24 and 34 weeks of gestational age.…”