Sleep Apnea Screening in Children With Sickle Cell Anemia

Abstract

Background: Screening for obstructive sleep apnea (OSA) is recommended by current guidelines in children with sickle cell anemia (SCA), but no specific approach is described. The Pediatric Sleep Questionnaire (PSQ) is a validated detection tool for OSA in children. We assessed the utility of PSQ to screen for OSA in children with concomitant SCA and snoring. Materials and Methods: A prospective study, in children 4 to 18 years old with SCA. Subjects were assessed for snoring and PSQ administered at the same visit. All children with snoring were then referred for polysomnography. Results: A total of 106 subjects were screened. Habitual snoring prevalence was 51/106 (48.1%). In the snoring group, OSA was detected in 83.9% (apnea-hypopnea index [AHI] ≥1.0/h) and 22.6% (AHI ≥5.0/h), respectively. Sensitivity and specificity of PSQ in children with snoring was 46.2% and 20.0% (AHI ≥1.0/h), and 57.1% and 50.0% (AHI ≥5.0/h), respectively. Physician assessment for snoring had a high sensitivity of 70.3% but low specificity of 58.4% (AHI ≥1.0/h), and 87.5% and 41.5% (AHI ≥5.0/h), respectively. Conclusion: PSQ is a poor screening tool for detection of OSA in those children with SCA who snore. Physician assessment for snoring could however be an initial approach before polysomnography.

Description of a Colocated Comprehensive Care Model for People With Sickle Cell and Comorbid Pulmonary Disease

“…2 Several factors can contribute to the development of chronic lung disease in SCD, including hemolysis and inflammation. 3 Common pulmonary complications include high rates of asthma (17% to 28%), [4][5][6] inflammation-induced nonasthmatic wheezing (19% to 30%), [7][8][9] obstructive sleep apnea (OSA; 10% to 40%), 5,10 and hospitalizations for acute chest syndrome (ACS). 11,12 ACS is the second most common cause of hospitalization for children with SCD and is described as a clinical syndrome that includes chest pain, fever, cough, hypoxia, tachypnea, or wheezing plus a new pulmonary infiltrate on imaging.…”