Prenatal, Perinatal, and Early Childhood Factors Associated with Childhood Obstructive Sleep Apnea

Abstract

Objectives: To investigate prenatal, perinatal, and early childhood factors, including cord and early childhood plasma leptin, on a clinical diagnosis of obstructive sleep apnea (OSA) among children in the Boston Birth Cohort.

Study design: We conducted a secondary analysis of 2867 mother-child pairs from the Boston Birth Cohort who were enrolled between 1998 and 2014 at Boston Medical Center and followed from birth to age 16 years. Child's OSA was defined based on clinical diagnoses documented in the medical record. Plasma leptin was measured in cord and early childhood blood samples. Logistic regression was used to examine individual and combined effects of early life factors on the risk of OSA, adjusting for potential confounders.

Results: The mean age of the study children was 6.39 years (SD = 3.77); 49.3% were girls, and 209 (7.3%) had ever been diagnosed with OSA. Four significant risk factors for OSA were identified: maternal obesity/diabetes during pregnancy (OR, 1.63; 95% CI, 1.21-2.21; P = .001), preterm/low birth weight (OR, 1.74; 95% CI, 1.30-2.32; P < .001), early childhood obesity (OR, 1.89; 95% CI, 1.37-2.62; P < .001), and high leptin levels in early childhood (OR, 1.94; 95% CI, 1.22-3.09; P = .005). The presence of all these 4 risk factors significantly amplified the odds of OSA by about 10 times (OR, 9.95; 95% CI, 3.42-28.93; P < .001) compared with those lacking these factors.

Conclusions: Our findings, if further confirmed, provide new insight into the early life risk factors of pediatric OSA and underscore the need for early screening and prevention of OSA among children with those risk factors.

Keywords: OSA; leptin; low birth weight; obesity; preterm birth.

Copyright © 2019 Elsevier Inc. All rights reserved.

Figures

Figure 1:

Combined association of maternal obesity/diabetes, preterm birth and low birth weight, and childhood obesity with first clinical diagnosis of Obstructive Sleep Apnea (OSA) in childhood, stratified by early childhood leptin tertiles. 1. Controlled for maternal age, parity, race/ethnicity, maternal smoking during pregnancy, child's gender, and child's age; 2. PTB: preterm birth; LBW: low birthweight; W: with; W/O: without. 3. * indicates p

Figure 2; online only:

Flow chart of the study participants.

Figure 3; online only:

Child BMI’s predictive margins of the probability of childhood Obstructive Sleep Apnea (OSA) with 95% confidence interval (CI). *Controlled for maternal obesity/diabetes, preterm birth/LBW, maternal age, parity, race/ethnicity, maternal smoking during pregnancy, child's gender, and child's age.

Figure 4; online only:

Incidence of childhood Obstructive Sleep Apnea (OSA) by age group.

Figure 5; online only:

Combined association of maternal obesity/diabetes, preterm birth and childhood obesity with first clinical diagnosis of childhood Obstructive Sleep Apnea (OSA) stratified by early childhood plasma Leptin levels (tertile). 1. Controlled for maternal age, parity, race/ethnicity, maternal smoking during pregnancy, child's gender, and child's age; 2. PTB: preterm birth; LBW: low birthweight.