Risk factors for sleep‐related hypoxia in primary school children

Abstract

Sleep-related hypoxia has adverse effects on cognition in children. Knowledge of factors contributing to sleep-related hypoxia is sparse. We aimed to identify demographic and clinical factors associated with mild (nadir arterial oxygen saturation 91-93%), moderate (nadir arterial oxygen saturation <or=90%), and recurrent (oxygen desaturation index > 3.9) sleep-related hypoxia in children. Parental questionnaires were distributed and overnight recordings of arterial oxygen saturation performed in a population-based cross-section of primary school children (n = 995). Associations were determined using unconditional logistic regression as well as unadjusted and adjusted odds ratios (OR), and their 95% confidence intervals (95% CI) calculated. Male sex, overweight (i.e., body mass index >or= 75th percentile), household smoking, symptoms of sleep-disordered breathing, a current respiratory tract infection, and histories of asthma and respiratory allergy were all significantly associated with sleep-related hypoxia. In multiple regression analysis, (i) overweight (OR, 95% CI: 2.7, 1.7-4.3) and a history of respiratory allergy (1.7, 1.1-2.7) were independent risk factors for mild sleep-related hypoxia, (ii) overweight (3.2, 1.7-5.8), a history of respiratory allergy (2.4, 1.4-4.4), and household smoking >10 cigarettes/day (1.8, 1.1-2.8) were independent risk factors for moderate sleep-related hypoxia, and (iii) overweight (2.3, 1.04-5.3), a history of respiratory allergy (2.5, 1.2-5.1), and a current respiratory tract infection (4.4, 2.0-9.8), were independent risk factors for recurrent sleep-related hypoxia. Our data suggest that overweight, passive smoking, respiratory allergies, and acute lung disease may independently contribute to sleep-related hypoxia in children.

Pediatric OSAS: Oximetry can provide answers when polysomnography is not available

“…We should remark that there is limited information on the potential differences between obese and normal weight children in terms of ODI, particularly when taking into consideration the effect of SDB [25e27]. In one population-based study, overweight or obese children were at risk of having an elevated ODI 4, but no polysomnographic evaluation was performed to exclude nocturnal hypoxemia related to OSAS [27].…”

Improving the diagnosis of obstructive sleep apnea in children with nocturnal oximetry-based evaluations

“…Oximetry seems less reliable in predicting the presence of OSA in obese children compared to normal-weight children. This could be attributed to the fact that overweight and obesity can be associated with the presence of sleep-related hypoxia even in the absence of OSA [7]. Also in patients with Down syndrome, oximetry seems to be less reliable as it has a higher night-to-night variability compared to other children [8].…”

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

“…47,[164][165][166][167] Fewer studies that included objective measurements to identify SDB were available. Two population-based studies using PSG demonstrated a relationship between overweight/obesity and OSAS.…”