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Elevation linked with increased risk for hospitalization in children with Down syndrome, OSA

Children with Down syndrome and obstructive sleep apnea at elevations greater than 1,500 meters exhibited a greater risk for hospitalization than children without Down syndrome who have obstructive sleep apnea, according to study results.

“Persons with obstructive sleep apnea (OSA) and Down syndrome appear to be disproportionately impacted by higher elevations compared to persons with OSA without Down syndrome,” Kristin M. Jensen, MD, MSc, of the University of Colorado School of Medicine, told Healio.com/Allergy. “Thus, providers should have a low threshold to screen for and treat OSA in persons with Down syndrome living at higher elevations.”

Kristin M. Jensen

Jensen and colleagues merged the 2009 Kids’ Inpatient Database (KID) with ZIP code-linked elevation data to analyze differences in the proportion of pediatric hospitalizations involving OSA, pneumonia and congenital heart disease (CHD) in patients with and without DS.

The researchers identified 1,564,596 discharges of patients aged 2 to 20 years with available hospital ZIP codes, of which 6,689 cases (0.4%) involved patients with DS.

The risk difference for a hospitalization in patients with DS and OSA at elevations higher than 1,500 meters (RD = 16.2; 95% CI, 9.2-23.2) was greater than patients with OSA but without DS (RD = 0.1; 95% CI, –0.4 to 0.7).

The relative risk for hospitalizations for OSA in patients with DS (RR = 2.49; 95% CI, 1.68-3.69) at the greater elevations was higher than in non-DS patients (RR = 1.11; 95% CI, 0.75-1.64).

The researchers said the study was limited because data from KID only includes encounter level data, and they were unable to determine if multiple encounters in the dataset resulted from the same patient. Also elevation was determined by hospital location, “not patient residence, which may inaccurately assign elevation categories in some circumstances,” the researchers wrote. –by Ryan McDonald

Disclosure: Jensen reports no relevant financial disclosures. Halbower reports being on the editorial board of Chest.