Socioeconomic inequalities in pediatric obstructive sleep apnea

Park, Ji Woon; Hamoda, Mona M.; Almeida, Fernanda R.; Wang, Zitong; Wensley, David; Alalola, Bassam; Alsaloum, Mohammed; Tanaka, Yasue; Huynh, Nelly; Conklin, Annalijn

doi:10.5664/jcsm.9494

Cited by 12 publications

(13 citation statements)

References 42 publications

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“…For example, a study by Wang et al found that higher poverty rates and a higher percentage of single‐female‐headed households were associated with a higher AHI in a sample of 774 children from six American cities 8 . In contrast, a study by Park et al found that certain markers of SES, such as maternal education and urban location, were associated with a higher AHI in a Canadian sample, 5 but did not find a significant association with perceived SES based on the MacArthur Scale of Subjective Social Status. In addition, Xie et al found no statistically significant differences in markers of SES, including median household income, single‐parent households, public insurance coverage, race, or age, between children with refractory and non‐refractory OSA following T&A 15 .…”

Section: Discussionmentioning

confidence: 97%

“…[4][5][6][7] In contrast, others have found that these associations are not statistically significant when controlling for confounders or using other measures of SES. 5,8 The area deprivation index (ADI) is a metric of neighborhood-level disadvantage that combines 17 social determinants of health, including education, employment, housing, and poverty measures, as reported in the American Community Survey. 9,10 It offers a comprehensive index that incorporates multiple facets of SES.…”

Section: Introductionmentioning

confidence: 89%

“…Some studies have identified certain socioeconomic factors associated with increased OSA severity, such as race, maternal education, and family income. [4][5][6][7] In contrast, others have found that these associations are not statistically significant when controlling for confounders or using other measures of SES. 5,8 The area deprivation index (ADI) is a metric of neighborhood-level disadvantage that combines 17 social determinants of health, including education, employment, housing, and poverty measures, as reported in the American Community Survey.…”

Section: Introductionmentioning

confidence: 89%

“…Despite several studies examining the relationship between socioeconomic status (SES) and OSA in children, the evidence is inconclusive. Some studies have identified certain socioeconomic factors associated with increased OSA severity, such as race, maternal education, and family income 4–7 . In contrast, others have found that these associations are not statistically significant when controlling for confounders or using other measures of SES 5,8 …”

Section: Introductionmentioning

confidence: 99%

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Assessment of neighborhood‐level disadvantage and pediatric obstructive sleep apnea severity

Kim

Kou

Chorney

et al. 2023

Laryngoscope Investig Oto

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ObjectivesTo examine the relationship between neighborhood‐level advantage and severe obstructive sleep apnea (OSA) in children.MethodsA retrospective case–control study was conducted on 249 children who underwent adenotonsillectomy and had full‐night polysomnography conducted within 6 months prior. Patients were divided into more or less socioeconomically disadvantaged groups using a validated measure, the area deprivation index (ADI). The primary outcomes were the relationship between the apnea–hypopnea index (AHI) and the presence of severe OSA, and the secondary outcome was residual moderate or greater OSA after tonsillectomy.ResultsOf the 249 children included in the study, 175 (70.3%) were socially disadvantaged (ADI > 50). The median (interquartile range [IQR]) age was 9.4 (7.3–12.3) years, 129 (51.8%) were male, and the majority were White (151, 60.9%), Black (51, 20.6%), and/or of Hispanic (155, 62.5%) ethnicity. A total of 140 (56.2%) children were obese. The median (IQR) AHI was 8.9 (3.9–20.2). There was no significant difference in the median AHI or the presence of severe OSA between the more and less disadvantaged groups. Severe OSA was found to be associated with obesity (odds ratio [OR] = 3.13, 95% confidence interval [CI] = 1.83–5.34), and residual moderate or greater OSA was associated with older age (OR = 1.20, 95% CI = 1.05–1.38).ConclusionsThe ADI was not significantly associated with severe OSA or residual OSA in this cohort of children. Although more neighborhood‐level disadvantage may increase the risk of comorbidities associated with OSA, it was not an independent risk factor in this study.Level of EvidenceLevel 4.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of neighborhood‐level disadvantage and pediatric obstructive sleep apnea severity

Kim

Kou

Chorney

et al. 2023

Laryngoscope Investig Oto

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“…In summary, results from CHAT-related studies confirmed previously observed associations between OSA and lower maternal education, urban settings, low education-level parental occupations, and low family income. 21,22 Although some predictors of OSA severity have been identified in secondary analyses, the factors associated with adverse outcomes in children with OSA and their response to treatment represent an important area for future research.…”

Section: Predictors Of Osa Severity Spontaneous Resolution and Treatm...mentioning

confidence: 99%

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Decuzzi

Redline

Isaiah

2022

JAMA Otolaryngol Head Neck Surg

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ImportanceAdenotonsillectomy, performed for approximately 500 000 children annually in the US alone, is the first line of treatment of pediatric obstructive sleep apnea (OSA). The Childhood Adenotonsillectomy Trial (CHAT), the first randomized clinical trial to test the efficacy of adenotonsillectomy, compared the management of pediatric nonsevere OSA by early adenotonsillectomy (eAT) vs watchful waiting with supportive care. Since the publication of the primary article in 2013, the CHAT study data set were made available via the National Sleep Research Resource, which allowed researchers to address a range of additional clinical questions relevant to the care of children with OSA. This review focuses on secondary analyses associated with the CHAT data set as grouped by the outcome of interest.ObservationsThe results of most secondary analyses suggest that children who underwent eAT experienced the greatest improvements in symptom burden, sleepiness, parent-reported behavior, and quality of life. Changes in other domains, such as cognition, cardiovascular physiology, and metabolic indicators, were modest and selective. The associations between most treatment outcomes and polysomnographic parameters were weak. Symptoms were poor predictors of OSA severity. The results from these secondary analyses benefitted from the rigor of multicenter design and centralized polysomnography interpretation in CHAT. However, the exclusion of younger preschool-aged children and children with primary snoring limited the generalizability of findings. In addition, because caregivers were not masked, some of the parent-reported outcomes may have been inflated.Conclusions and RelevanceThe results of this narrative review suggest that CHAT provides a model for future OSA-related studies in children for design, conduct, and subsequent reuse of the study data set, and its findings have advanced our understanding of the pathophysiology and management of pediatric nonsevere OSA. Directions for future research include whether the findings from this landmark study are generalizable to younger children and children with primary snoring and severe OSA. Similar studies may help address practice variability associated with pediatric OSA and help identify children who are most likely to benefit from undergoing eAT.

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Future directions

Kang,

Hsu

2024

Snoring and Obstructive Sleep Apnea in Children

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Socioeconomic inequalities in pediatric obstructive sleep apnea

Cited by 12 publications

References 42 publications

Assessment of neighborhood‐level disadvantage and pediatric obstructive sleep apnea severity

Assessment of neighborhood‐level disadvantage and pediatric obstructive sleep apnea severity

Secondary Analyses of the Childhood Adenotonsillectomy Trial

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