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Pediatrics. 2014 Aug;134(2):273-81. doi: 10.1542/peds.2013-4223. Epub 2014 Jul 14.

Obstructive sleep apnea and sickle cell anemia.

Author information

1
Department of Pediatrics and Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio; carol.rosen@case.edu.
2
Vanderbilt University School of Medicine and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee;
3
Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri;
4
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
5
Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio;
6
Department of Pediatrics and Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio;
7
Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, United Kingdom;
8
North Middlesex Hospital National Health Service Trust, London, United Kingdom;
9
Evelina Children's Hospital, Guy's and St Thomas Hospital, London, United Kingdom;
10
Department of Paediatrics, Imperial College and Imperial College Healthcare National Health Service Trust, London, United Kingdom;
11
Independent statistician, Chicago, Illinois; and.
12
University College London Institute of Child Health, London, United Kingdom.

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 SCA-related 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 in-laboratory 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 β(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 (Spo2), reduced lung function, less caretaker education, and non-preterm birth. Lower sleep-related Spo2 metrics were also associated with higher obstructive apnea hypopnea indices. In multivariable analyses, habitual snoring and lower waking Spo2 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 Spo2 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.

KEYWORDS:

blood disorders; cohort study; epidemiology; obstructive sleep apnea; polysomnography; sickle cell anemia; sleep disorders; sleep medicine

PMID:
25022740
PMCID:
PMC4187233
DOI:
10.1542/peds.2013-4223
[Indexed for MEDLINE]
Free PMC Article
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