Age-Related Clinical and Polysomnographic Features of Severe Obstructive Sleep Apnea in Infants.

ABSTRACT

OBJECTIVE: To use clinical and polysomnographic (PSG) parameters to define the features of severe OSA in infants including PSG parameters, risk factors, and interventions. METHODS: Retrospective comparison of PSG features in 207 infants (<12 months) referred for sleep-disordered breathing. Stepwise multivariate logistic regression was used to define risk factors for severe OSA including sleep stage-specific PSG parameters. Oxygenation was assessed as % of time with SpO2 < 90% nadir with apneic events and frequency of SpO2 desaturations (>3%) calculated as stage-specific O2 desaturation indexes. RESULTS: We found that 43% of the infants had an OAHI ≥10/h (90/207) with 152 analyzed due to lack of follow-up. Age is the strongest predictor for severe OSA with infants at or less than 3 months of age with 6.22 higher risk of severe OSA (95% CI, 3.16-12.27). Age-stratified analyses showed that infants ≤3 months had significantly higher total and OSA sleep stage-specific apnea hypopnea (OAHI) indexes (REM and NREM), hypopnea indexes (HI), obstructive apnea indexes (OI), arousal indexes, and more severe hypoxemia, both sustained and intermittent. The top risk factor in infants ≤3 months was craniofacial abnormality, which occurred in 57.9% of cases. No intervention was the most common management for each group (61.1% in ≤3 months and 56.6% in 4-12 months). The most common procedures in infants ≤3 months were mandibular distraction osteogenesis (MDO) and supraglottoplasty (SGP) while adenoidectomy was the most common in the 4- to 12- month group. CONCLUSION: Diagnosis ≤3 months is the strongest predictor for severe OSA, demonstrated across PSG parameters. No surgical intervention is the most common management. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.