Demographics, Clinical, and Polysomnographic Characteristics of Children under 3 with Obstructive Sleep Apnea

INTRODUCTION: Pediatric obstructive sleep apnea (OSA) most commonly affects children 3 years or older. Very few studies describe the epidemiology and predictors of pediatric OSA in children under 3 years of age. OBJECTIVES: To describe the demographic, clinical, and polysomnographic characteristics of children under 3 years of age referred for polysomnography (PSG). To identify demographic and clinical features that predict severe OSA in this cohort of children. METHODS: This study reviewed all children under 3 years of age who underwent PSG between 08/01/2012-06/01/2017 at UT Southwestern/Children's Medical Center in Dallas and had complete data. Demographic, clinical, and PSG data were obtained from the electronic medical records. The following comparisons were made: obese versus non-obese; age 0-1 and 1-3; children with or without significant comorbidities. Pearson chi-squared was used for categorical data and ANOVA for continuous data. Logistic regression was used to look for predictors of severe OSA. A P<0.05 was considered significant. RESULTS: Three hundred thirty-two patients were included in this study, 17% of which were between 0-1 years, and 82% were between 1-3 years. Two hundred sixteen patients were male (65%).The cohort was comprised of 86 (26%) Caucasian, 86 (26%) African American, 138 (42%) Hispanic, and 22 (6.6%) patients that identified as Other. Co-morbidities included 59 (18%) preterm patients, 64 (19%) with allergic rhinitis, 88 (27%) with gastroesophageal reflux, 55 (17%) with asthma, 14 (4.2%) with down syndrome, 25 (7.5%) with cardiac issues, 31 (9.3%) with craniofacial issues, and 6 (1.8%) with sickle cell disease. A total of 163 (49%) patients had tonsillar hypertrophy (tonsil size of 3+ to 4+). Comparison of the two age groups 0-1 and 1-3 years, obese versus non-obese and with or without comorbidities showed no significant differences in clinical or PSG data. Severe OSA was predicted by tonsillar hypertrophy (OR=1.97: p=0.005). CONCLUSION: Children under 3 with OSA are more likely to be male and have a variety of comorbidities. Tonsillar hypertrophy is the primary predictor for severe OSA in young children. Additional research is needed to determine the outcomes of surgical therapy for OSA in children under 3.