Young Children With Stunted Growth Have Greater Risk for More Severe OSA

Children 3 to 6 years of age at risk for obstructive sleep apnea (OSA) who have stunted growth may be at risk for more severe OSA, according to study findings published in the International Journal of Pediatric Otorhinolaryngology.

Researchers in China sought to evaluate the effect of growth and development levels in young children with OSA. They conducted an observational study of 183 children (72 girls and 111 boys, 3-6 years of age) who were evaluated for snoring and diagnosed with OSA by polysomnography (PSG) between January 2019 and December 2021 at the Children’s Hospital of Nanjing Medical University in China. The children were stratified based on weight and body mass index (BMI) into growth-rate groups identified by the World Health Organization (WHO), with 26 children categorized as growth restricted; 112 categorized as growth normal; and 45 categorized as overgrowth. Investigators compared the 3 groups with respect to sleep structure, breathing events, and oxygenation index.

The investigators noted that height and sex differences among children the 3 groups of children was not statistically different. However, there was a statistically significant difference between the normal growth group’s median age of 4.95 years and the median age of children in the other 2 groups, which was 5.0 years for both (P <.05).

With respect to sleep structure, the researchers observed poorer sleep efficiency in the growth restricted group vs growth normal (P <.05). Total sleep time and wake after sleep onset were lower in the growth restricted group than the normal growth group, but without statistical significance (P >.05). There was no discernable difference observed in sleep patterns between children in the overgrowth group and those in the normal growth group.

With respect to breathing events, the growth restricted group showed more hypoventilation as well as a higher scores than the normal growth group (P <.05) for the hypoventilation index, obstructive apnea hypopnea index (OAHI), and apnea-hypopnea index (AHI).

With respect to hypoxia, children in the overgrowth group had a lower minimum oxygen saturation during the rapid eye movement phase and a quicker mean heart rate than those in the normal growth group. The difference in heart rate between the growth restricted group and the normal growth group was not statistically significance (P >.05).

Study limitations include the study’s inclusion of only children who had snoring symptoms and the small sample of children in the growth restricted and overgrown groups.

“The results of the study suggest that the more factors that contribute to OSA [that] are present in the child, the greater the risk of OSA and the more severe the condition, especially when combined with stunted growth,” said study authors. “Children with growth restriction who develop clinical symptoms related to OSA during sleep should have a PSG as early as possible to confirm the diagnosis and begin treatment as soon as possible to help improve the child’s quality of life and reduce the long-term consequences of stunting and OSA,” the study authors noted.