Morbidity and Mortality in Children With Obstructive Sleep Apnoea: a Controlled National Study

Due to the fact that very little is known about obstructive sleep apnoea patterns in children, a study has been undertaken to appraise morbidity and mortality in childhood obstructive sleep apnoea. The research was groundbreaking since most studies have only concentrated on adult OSA and associated effects.

Obstructive sleep apnoea is a common problem for children as well. It has deleterious effects in the health of the child. Childhood sleep apnoea is associated with cognitive impairment, diminished quality of life, behavioral disorders, obesity and overweight issues, high blood pressure and daytime sleepiness among other health problems.

The research setting was Denmark and involved patients between the ages of 0-19. The patients were diagnosed with sleep apnoea between the years 1997 and 2009 and were identified from the Danish National Patient Registry. The NPR is a thorough and accurate database of all patient conditions including obstructive sleep apnoea encountered and treated across the country. 2,998 patients with a diagnosis of sleep apnoea were identified and for each patient four citizens were randomly selected in a match of sex, age and socioeconomic status. The NPR also allowed that each of the subjects could be followed both prospectively and retrospectively.

The evaluation of morbidity was done before the diagnosis of OSA and the data was extracted as both primary and secondary diagnoses. Childhood OSA was positively associated with infections; tonsillitis, endocrine, nutritional and metabolic diseases; nervous, ENT disorders, neurological disease, gastrointestinal diseases; skin conditions; congenital malformations, head trauma and asthmatic bronchitis.

In the evaluation of mortality, the twelve year death rates between 1997 and 2009 showed a significant difference between that of patients with OSA and the controls. The differences noted for the controlling between genders were insignificant. Attention is drawn to the 5-year death rate which was 70 per 10,000 for the OSA patients and was 11 per 10,000 for the controls.

Therefore, the study indicates that children who have had a diagnosis of OSA have numerous different morbidities before the diagnosis. This includes abnormalities and a wide range of diseases with the airways, nutritional and metabolism related conditions, and all previously listed conditions. OSA is common in children and it mostly goes undiagnosed and untreated. The study found that OSA is often first diagnosed when a child's function is affected and specific data regarding the extent, severity and consequences are sparse. Little is known about the effect of treatment with continuous positive airway pressure (CPAP) in children especially the limitation of its use in patients with special needs such as cerebral palsy or other neurological, muscular and genetic disorders. In conclusion, children and teenagers have a wide range of morbidities at least 3 years before and after the diagnosis of OSA.

Mortality was found to be higher in children with OSA than those in the controls. The study did not consider whether this was related to the consequences of OSA or of comorbid diseases. The study of children and adolescents up to 19 years of age was done to evaluate potential known and unidentified comorbidities in OSA, and revealed that many known risks are associated with late diagnosis of OSA.

http://thorax.bmj.com/content/early/2013/06/07/thoraxjnl-2012-202561.

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