Screening for Obstructive Sleep Apnea in Children With Sickle Cell Disease: A Pilot Study

Abstract

Objectives/Hypothesis Obstructive sleep apnea (OSA) and sickle cell disease (SCD) represent two complex disease processes. Current guidelines recommend that children with SCD receive polysomnography (PSG) after presenting with signs or symptoms of sleep‐disordered breathing (SDB). Recent studies suggest a disproportionately elevated prevalence of SDB in the population of children with SCD, and traditional risk factors may not be evident within these patients. Further objective testing might be needed to screen all pediatric patients with SCD, even in the absence of overt signs or symptoms of OSA to prevent complications of both conditions. Study Design Prospective cohort study. Methods Institutional review board approval was obtained. An eight‐question OSA risk assessment screening questionnaire was presented prospectively to 100 consecutive patients with SCD in the pediatric hematology clinic regardless of complaints of SDB. Results Out of 100 patients, 51 were female. The average age, body mass index (BMI), BMI percentile, and I'M SLEEPY score of the entire cohort were 3.97 years, 15.97%, 55.4%, and 1.63%, respectively. Nineteen patients had a positive sleep apnea screening score and were referred for PSG. The average age BMI, BMI percentile, and I'M SLEEPY score for those 19 patients were 3.77%, 16.67%, 65%, and 3.95%, respectively. Ten patients completed PSG, with seven diagnosed with OSA. Conclusions This pilot study demonstrates a higher incidence of SDB and OSA in children with SCD relative to the general pediatric population. Although more PSG reports and further testing is needed to determine whether the results hold, preliminary data indicate that children with SCD should at least undergo OSA screening in the office regardless of overt symptoms. Level of Evidence 3 Laryngoscope, 131:E1022–E1028, 2021

The burden of sleep disordered breathing in children with sickle cell disease

“…In a recent prospective study, 29 out of 100 children with SCD who were screened with a specific sleep questionnaire regardless of symptoms of SDB, 19 had a positive sleep apnea screening score 47 . Ten patients underwent PSG and seven were diagnosed with OSA 29 .…”

“…In a recent prospective study, 29 out of 100 children with SCD who were screened with a specific sleep questionnaire regardless of symptoms of SDB, 19 had a positive sleep apnea screening score 47 . Ten patients underwent PSG and seven were diagnosed with OSA 29 . Two previous prospective case‐control studies reported results of the Children's Sleep Habits Questionnaire (CSHQ) administered to two different cohorts of patients compared with healthy controls 31,33 .…”

“…The burden of SDB in children with SCD has been extensively studied 9,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] (Table 1).…”

“…47 Ten patients underwent PSG and seven were diagnosed with OSA. 29 Two previous prospective case-control studies reported results of the Children's Sleep Habits Questionnaire (CSHQ) administered to two different cohorts of patients compared with healthy controls. 31,33 Preschool children with SCD had a much higher frequency of sleep issues than their peers without SCD, in particular with regard to SDB symptoms, 31,33 and night waking.…”

Pediatric pulmonary year in review 2021: Sleep medicine

“…The authors concluded that OSA was confirmed as an independent risk factor for NC among patients hospitalized with SCD and that noninvasive mechanical ventilation may modify the risk of OSAassociated NC in SCD children. 26 To identify patients with comorbid sleep-disordered breathing and SCD early, Maroda et al 27 seven diagnosed with OSA with an average AHI of 2.5 events/ h (±2.3). The authors conclude that there may be a higher incidence of OSA among the SCD population and that screening for OSA, even without overt symptoms, can detect early sleep-disordered breathing in this population.…”