The Natural History of Snoring in Children With Sickle Cell Anemia in Relation to Upper Airway Anatomy and OSA.

BACKGROUND

Though children with sickle cell anemia (SCA) possess an elevated risk for sleep-disordered breathing (SDB), progression of obstructive sleep apnea (OSA) across childhood and optimal screening approach remain unclear. Improved understanding of SDB symptomatology and relationship to OSA may simplify screening. This study longitudinally describes SDB symptom profile in children with SCA and examines how they evolve in relation to upper-airway anatomy.

METHODS

Patients with SCA aged 2-18 years were prospectively recruited. Demographic data, clinical assessments, and upper airway examinations were obtained. OSA symptoms were compared to polysomnography (PSG) outcomes and anatomical features.

RESULTS

Habitual snoring was the most common symptom (n = 55/153;36%). Among PSG-qualifying participants (n = 92/153;60%), most exhibited overlapping symptoms (n = 54/92;58.7%), of which 78% co-occurred with habitual snoring. Remaining single qualifying SDB symptoms included habitual snoring (14.1%) vs others (27.2%). PSG performed in 49/92 (53.3%) children confirmed 23 OSA cases; 19 (82.6%) with habitual snoring, 3 (13%) mouth breathing, and 1 (4.3%) stroke. Habitual snoring but not other SDB symptoms was associated with OSA (p = 0.017). Tonsillar hypertrophy (p = 0.003) and higher Mallampati scores (p = 0.041) predicted habitual snoring. Although habitual snoring prevalence and mean upper-airway anatomical measures cross-sectionally appeared stable (p = 0.602), dynamic longitudinal interactions were observed. New-onset snoring among baseline non-snorers (27.9%) was associated with larger tonsils, whereas snoring resolution in habitual snorers (40.4%) was associated with lower Mallampati scores.

CONCLUSION

In SCA, habitual snoring as opposed to other symptoms is a practical clinical indicator for the preliminary assessment of OSA. Emergence and resolution of habitual snoring reflect dynamic upper-airway anatomical changes, underscoring importance of periodic reassessments.