Morbidity and mortality from obstructive sleep apnea in children and their parents: a controlled national study.

BACKGROUND

Childhood obstructive sleep apnea (cOSA) is associated with increased morbidity and mortality, but little is known about its pre-diagnostic morbidity or that of parents of children with OSA. We aim to study pre-diagnostic morbidities, mortality, and parental comorbidity, including the effect of parental OSA (pOSA) on cOSA.

METHODS

2821 patients with OSA aged 3-19 years with a diagnosis of OSA were identified from the Danish National Patient Registry. For each patient, we randomly selected four citizens matched by age, gender, and socioeconomic status, thereby providing 9901 control subjects.

RESULTS

cOSA had greater morbidity at least 3 years before their diagnosis in all WHO 21 disease classes. This was most pronounced for endocrine and metabolic (OR: 3.2; 95 % CI: 2.6-4.0), neurological (OR: 5.4; 95 % CI: 4.1-7.2) and respiratory (OR: 6.7; 95 % CI: 6.0-7.4) diseases. cOSA was strongly correlated with later comorbidities in all disease domains. Five-year mortality was 18 per 10,000 for patients and 2 per 10,000 for controls. The hazard ratio for cases compared with controls was 3.8 (95 % CI: 1.7-8.4). All associations persisted when those with congenital disorders were excluded from the analyses. pOSA comorbidities showed a similar disease pattern to that of children. pOSA and cOSA are strongly associated, with a OSA odds ratios for parents compared to control parents of 2.3 (95 % CI, 1.6-3.3) for fathers and 8.7 (95 % CI, 3.6-21.2) for mothers.

CONCLUSIONS

Children with OSA have significant morbidities and cOSA is associated with significant mortality, as is also found in the parental population. There is a strong familial risk for cOSA and co-existence of comorbidities in all domains.