Children treated for OSA less likely to have mental health care visits
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Key takeaways:
- Children with OSA did not have as many new mental health care encounters as those without OSA.
- Children treated with adenotonsillectomy vs. PAP had greater decreased odds for mental health care visits.
Children with obstructive sleep apnea treated with adenotonsillectomy/positive airway pressure faced reduced odds for mental health care visits vs. before treatment, according to results published in Annals of the American Thoracic Society.
“Our findings provide evidence to support OSA as a potential modifiable risk factor for mental health disorders, suggesting that early detection and treatment of OSA in children can potentially contribute to better mental health trajectories and reduce the burden of mental health disorders,” Tetyana Kendzerska, MD, PhD, associate scientist at Ottawa Hospital Research Institute and associate professor in the division of respirology at the University of Ottawa, told Healio.
In a retrospective population-based cohort study, Kendzerska and colleagues assessed 32,791 children with diagnostic polysomnography (PSG) data between 2009 and 2016 in Ontario, Canada, to find out the impact of moderate-severe OSA on new mental health care encounters up to March 2021, as well as how 2 years of OSA treatment changes the likelihood for this type of encounter.
Researchers used baseline characteristics of the 7,724 children (median age, 8 years; 60.6% boys) classified as having moderate-severe OSA based on PSG to weigh them by propensity score to the remaining 25,067 children (median age, 13 years; 55.6% boys) without OSA based on PSG.
Notably, treatment with either adenotonsillectomy or PAP for OSA was reported by 91.7% of those with PSG-OSA.
Kendzerska told Healio that this study population had heightened rates of mental health visits vs. a general pediatric population prior to adjustment.
“It was not surprising but important to see that mental health visit rates in children who underwent PSG (sleep study) in our research study, regardless of OSA status, were higher than in the general pediatric population using the same definitions for mental health visits,” she said. “Over a median follow-up of 7.7 years since the sleep study, 69% of children experienced at least one mental health care encounter: 8% were hospitalized at least once, 18% attended ER at least once and 68% experienced at least one mental health-related outpatient encounter.”
Through weighted cause-specific Cox proportional hazards models, researchers observed that the time from PSG to first mental health care encounter was shorter among those with vs. without OSA based on PSG (HR = 1.08; 95% CI, 1.05-1.12).
This outcome appeared to be driven by the time to a mental health outpatient visit between those with vs. without PSG-OSA (HR = 1.09; 95% CI, 1.05-1.12) rather than time to a mental health-related ED visit (HR = 0.83; 95% CI, 0.77-0.9) or hospitalization (HR = 0.83; 95% CI, 0.74-0.94).
Despite a quicker time to first encounter, those with OSA on PSG did not have as many new mental health care encounters as those without OSA on PSG (RR = 0.92; 95% CI, 0.87-0.97) using modified Poisson regression models.
According to researchers, this outcome was seen across the three types of mental health care encounters, with outpatient visits reaching statistical significance.
In a different analysis using age-adjusted conditional logistic regression models, researchers specifically evaluated children treated with adenotonsillectomy or PAP for OSA and collected data from 2 years before and after the treatment.
In the 2 years following vs. before these treatments, the child’s likelihood for mental health care encounters was reduced (OR = 0.69; 95% CI, 0.65-0.74), according to researchers. When assessing the two treatment options individually, children treated with adenotonsillectomy vs. PAP had greater decreased odds for this outcome (OR = 0.64; 95% CI, 0.6-0.69 vs. OR = 0.81; 95% CI, 0.74-0.9).
Reflecting on the study, Kendzerska pointed out several strengths including the use of “real-life population-level databases (generalizable) with a relatively large sample size, indicators leveraging objective sleep testing and a longitudinal perspective with nearly complete follow-up.”
Importantly, this study also had limitations, Kendzerska said.
“Detailed results from a sleep study, adherence to treatment and the effectiveness of OSA-related treatment were unavailable,” she told Healio.
“Future studies are needed to evaluate the impact of OSA treatment on mental health through prospective cohorts and clinical trials, addressing the limitations of our study,” Kendzerska added. “Future studies should address how socioeconomic disparities influence the relationship between OSA and mental health disorders.”
Perspective
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This study explored possible associations of OSA and mental health disorders. It also explored, if a child was diagnosed with OSA, if treatment of OSA was associated with a change in encounters for mental health disorders.
There are several strengths to the study, including the use of a comprehensive national database with very few missing data points, and studying many children (7,724 with moderate or severe OSA and 25,067 without moderate or severe OSA).
There are several limitations to this study as well, such as including children with mild sleep apnea in the no-OSA comparison group, and there is an age difference of approximately 4 years between the average age of the two groups. Children in the no-OSA group were on average aged 12 years, and the children in the moderate or severe sleep apnea group were aged 8 years.
We also do not know how they scored sleep apnea on the sleep studies, such as taking note of how many times the brain was disrupted from sleep (as an arousal) vs. if oxygen levels dropped (3% or 4% from baseline) or both measures.
The authors found some paradoxical results including that children with OSA did not have more encounters for mental health care. On the other hand, for the children with OSA who then underwent a treatment, they found the children had fewer encounters for mental health after the sleep apnea treatment than before treatment. This highlights the complex relationship between mental health disorders and sleep disorders.
This work was important to explore and look for associations so that future research can further explore how sleep affects mood and mental health and vice versa. However, it is possible that the age of the children in each group may be quite important; there is always some component of watchful waiting of any symptoms before parents discuss them with the child’s pediatrician and express a desire for more evaluation. Or it could be that the effect of the disorder becomes more notable as schoolwork difficulty or stress increases, which could lead to more mental health disorders being identified as the children near teenage years.
In evaluating the results of this study, it is clear that health care providers should consider assessing for mental health problems in all children who present with sleep-related concerns and vice versa. Treatment of both sleep disorders and mental health disorders is likely to offer children the best possibility for improved quality of life, academic performance and mental well-being.
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