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J Clin Sleep Med. 2019 Oct 30. pii: jc-19-00239. [Epub ahead of print]

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

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Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Pediatric Pulmonology, Sleep and CF Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
Neonatal Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Child Health, MU Women's and Children's Hospital, University of Missouri School of Medicine, Columbia, Missouri.



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.


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.


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.


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.


central apnea; failure to thrive; prematurity; sleep-disordered breathing


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