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Pediatric sleep apnea and craniofacial anomalies: A population-based case–control study§

Authors

  • Derek J. Lam MD, MPH,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A.
    • Department of Otolaryngology–Head and Neck Surgery, University of Washington Medical Center, BB1165, Box 356515, 1959 NE Pacific Street, Seattle, WA 98195
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  • Christine C. Jensen MD, MPH,

    1. Department of Surgery,University of Washington, Seattle, Washington, U.S.A.
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  • Beth A. Mueller DrPH,

    1. Department of Epidemiology, University of Washington, Seattle, Washington, U.S.A.
    2. Fred Hutchinson Cancer Research Center, Seattle, Washington, U.S.A.
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  • Jacqueline R. Starr MS, MPH, PhD,

    1. Department of Epidemiology, University of Washington, Seattle, Washington, U.S.A.
    2. Department of Pediatrics, University of Washington, and Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A.
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  • Michael L. Cunningham MD, PhD,

    1. Department of Pediatrics, University of Washington, and Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A.
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  • Edward M. Weaver MD, MPH

    1. Department of Otolaryngology–Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A.
    2. University of Washington Comparative Effectiveness, Cost & Outcomes Research Center, Harborview Medical Center, Seattle, Washington, U.S.A.
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  • All work was performed at the University of Washington, Seattle, Washington.

  • Presented at the 2006 Annual Meeting of the American Cleft Palate–Craniofacial Association in Vancouver, Canada, April 2–8, 2006.

  • §

    Financial disclosures: NIH/NIDCR F32 DE017268-01 (PI: Lam); NIH/NIDCD T32 DC00018 (PI: Weymuller); NIH K30 HL04136-05 (PI: Probstfield); NIH/NHLBI K23 HL68849 (PI: Weaver); none of the authors have any financial interests or other financial disclosures.

  • The authors declare that there are no conflicts of interest.

Abstract

Objective:

To investigate the association between craniofacial anomalies and diagnosis with obstructive sleep apnea (OSA) in a large, population-based sample of children.

Design:

Retrospective case–control study.

Methods:

Cases of OSA (n = 1,203) were identified by International Classification of Diseases-9 codes consistent with OSA in the 1987–2003 Washington State inpatient discharge database among children ≤18 years of age and born in Washington state. For each case, five controls without OSA (n = 6,015) were randomly selected from the remaining Washington State births, frequency matched by birth year. Congenital anomaly diagnoses and covariates were extracted from discharge data for all inpatient hospitalizations during the study period and linked birth certificate data. Multiple logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between congenital anomalies (including subgroups) and OSA.

Results:

An OSA diagnosis was strongly associated with the presence of any craniofacial anomaly (adjusted OR 38, 95%CI [24, 60]) and, in particular, with orofacial cleft (adjusted OR 40, 95%CI [17, 94]) and Down syndrome (adjusted OR 51, 95%CI [20, 128]). OSA was less associated with any noncraniofacial malformation (adjusted OR 4.1, 95%CI [3.1, 5.3]), which may reflect the relatively small effect of inpatient exposure bias in the associations above.

Conclusions:

The presence of congenital craniofacial anomalies is strongly associated with inpatient diagnosis of OSA. These findings persist even after control of major potential biases. Parents and clinicians should consider screening for OSA among children with craniofacial anomalies. Laryngoscope, 2010

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