Infants hospitalized with lower respiratory tract infections during the first two years of life have increased risk of pediatric obstructive sleep apnea

Authors

Mirtha G. Gayoso-Liviac, Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA.
Gustavo Nino, Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA.
Agnes S. Montgomery, Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA.
Xiumei Hong, Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Xiaobin Wang, Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Maria J. Gutierrez, Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Document Type

Journal Article

Publication Date

12-28-2023

Journal

Pediatric pulmonology

DOI

10.1002/ppul.26810

Keywords

hospitalized infants; lower tract respiratory infections; pediatric obstructive sleep apnea

Abstract

RATIONALE: Lower respiratory tract infections (LRTI) during the first 2 years of life increase the risk of pediatric obstructive sleep apnea (OSA), but whether this risk varies by LRTI severity is unknown. METHODS: We analyzed data from 2962 children, aged 0-5 years, with early-life LRTI requiring hospitalization (severe LRTI, n = 235), treated as outpatients (mild LRTI, n = 394) and without LRTI (reference group, n = 2333) enrolled in the Boston Birth Cohort. Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariables were used to evaluate the risk of pediatric OSA. RESULTS: Compared to children without LRTI, those with mild LRTI were at a higher risk of having OSA (hazard ratio [HR] 1.44, 95% confidence interval [CI]: 1.01-2.05), and those with severe LRTI were at the highest risk (HR 2.06, 95% CI: 1.41-3.02), independently of relevant covariables (including maternal age, race, gestational age, and type of delivery). Additional risk factors linked to a higher risk of OSA included prematurity (HR 1.34, 95% CI 1.01-1.77) and maternal obesity (HR 1.82, 95% CI 1.32-2.52). The time elapsed between LRTI and OSA diagnosis was similar in mild and severe LRTI cases, with medians of 23 and 25.5 months, respectively (p = .803). CONCLUSION: Infants with severe early-life LRTI have a higher risk of developing OSA, and surveillance strategies to identify OSA need to be particularly focused on this group. OSA monitoring should continue throughout the preschool years as it may develop months or years after the initial LRTI hospitalization.

APA Citation

Gayoso-Liviac, Mirtha G.; Nino, Gustavo; Montgomery, Agnes S.; Hong, Xiumei; Wang, Xiaobin; and Gutierrez, Maria J., "Infants hospitalized with lower respiratory tract infections during the first two years of life have increased risk of pediatric obstructive sleep apnea" (2023). GW Authored Works. Paper 3911.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3911

Department

Pediatrics