Severe OSA linked to obesity, not neighborhood-level deprivation in children
Click Here to Manage Email Alerts
Key takeaways:
- Living in a deprived vs. not deprived area did not significantly alter the risk for severe obstructive sleep apnea.
- Obesity increases the risk for more severe OSA.
Among individuals aged 18 years or younger, neighborhood-level deprivation did not raise the odds for severe obstructive sleep apnea, according to results published in Laryngoscope Investigative Otolaryngology.
However, individuals in this age range with obesity faced a heightened risk for severe OSA, according to researchers.
“Obesity significantly influences the onset of severe OSA as children grow older,” Romaine F. Johnson, MD, MPH, FACS, director of quality and safety in otolaryngology-head and neck surgery at UT Southwestern Medical Center and pediatric otolaryngologist at Children’s Health, told Healio. “The prevalence of undiagnosed severe OSA might be higher than anticipated. This suggests that more obese children should perhaps undergo sleep evaluations in conjunction with weight management programs. However, there are still unanswered questions about how OSA impacts older children and adolescents, especially in areas like cognition, growth and cardiovascular health.”
In a retrospective case-control study, Johnson and colleagues evaluated polysomnography results from 249 children aged 18 years old or younger (median age, 9.4 years; 51.8% boys; 56.2% with obesity; 60.9% white; 62.5% Hispanic) before they underwent an adenotonsillectomy procedure to determine whether neighborhood socioeconomic deprivation is linked to apnea-hypopnea index (AHI) and severe OSA.
To categorize children based on their neighborhood-level advantage, researchers used area deprivation index (ADI) national ranks, in which higher ranks signal residence in deprived neighborhoods.
Researchers found that a little over two-thirds (70.3%; n = 175) of children had an ADI rank greater than 50, which was significantly linked to Hispanic ethnicity (P = .013), public insurance (P = .004) and asthma (P = .028). The remaining children (29.7%; n = 74) had lower scores.
Of the total cohort, median AHI was 8.9 events per hour, and this measurement along with non-REM sleep, REM sleep, sleep efficiency, oxygen saturation nadir and peak end-tidal carbon dioxide level did not significantly differ between those with high vs. low ADI ranks.
Further, researchers observed a comparable frequency of severe OSA among those with and without social disadvantage.
“It's somewhat surprising that neighborhood-level disadvantages don't seem to influence the incidence of severe OSA in this group of children,” Johnson told Healio. “However, the study’s scope is limited by its location and sample size. It’s possible that, unlike asthma, OSA isn’t as influenced by one’s living environment.”
Despite these findings, researchers did find heightened odds for severe OSA with obesity (OR = 3.13; 95% CI, 1.83-5.34) and when Spanish was the preferred language among the family (OR = 1.96; 95% CI, 1.07-3.57) in a multiple logistic regression model.
“Our ongoing research aims to understand the relationship between weight and OSA severity,” Johnson told Healio. “For instance, our data show that between 30% to 50% of obese children referred for full-night polysomnography have severe OSA (AHI > 10 or SpO2 nadir < 80%). Interestingly, half do not. Moreover, about 20% have an AHI [less than] 5, which is considered normal in adults. The benefits of treating children with an AHI [less than] 5 vs. mere observation remain ambiguous.”
Additionally, children of older age had elevated odds for residual moderate or greater OSA (AHI 5) following tonsillectomy (OR for a 1-year older increase = 1.2; 95% CI, 1.05-1.38), with a predicted probability of 12.3% for children aged 5 years and of 19.6% for those aged 17 years.
When divided based on race, ethnicity and insurance type, severe, very severe and residual OSA did not significantly differ among the subgroups.
“A broader issue is the need to delve deeper into socioeconomic indices, rather than solely focusing on factors like race, payer status and income,” Johnson said. “Strategies based on neighborhood-level effects might have a wider appeal and could potentially withstand legal scrutiny. Nonetheless, I firmly believe that continued advocacy centered on race, class and payer status is essential and resonates with the principles of justice and equality.”
Reference:
- Obesity plays key role in children’s sleep apnea. https://www.utsouthwestern.edu/newsroom/articles/year-2023/aug-obesity-children-sleep-apnea.html. Published Aug. 9, 2023. Accessed Aug. 11, 2023.