Long-term health outcomes of pediatric obstructive sleep apnea: A 10-year multicenter cohort study.

OBJECTIVES

To evaluate the long-term associations between pediatric obstructive sleep apnea (OSA) and multiple domains of child health and to examine potential differences according to surgical treatment.

METHODS

We conducted a retrospective cohort to assess children aged 2-18 years with newly diagnosed OSA confirmed by polysomnography (PSG) who were followed for up to 10 years. Three cohorts were constructed: non-surgically treated OSA, surgically treated OSA who underwent adenotonsillectomy, and age-matched healthy controls. Outcomes included growth failure, delayed developmental milestones, obesity, precocious puberty, and attention-deficit/hyperactivity disorder (ADHD). Propensity score matching and Cox proportional hazards models were used to estimate long-term risks.

RESULTS

Children with non-surgically treated OSA demonstrated higher risks of growth failure (HR: 1.97, P < 0.001), delayed developmental milestones (HR: 2.48, P < 0.001), obesity (HR: 1.51, P < 0.001), precocious puberty (HR: 1.59, P < 0.001), and ADHD (HR: 1.66, P < 0.001). These risks emerged early after diagnosis and persisted during follow-up. Younger children showed greater susceptibility to growth and developmental outcomes, whereas obesity became more evident at older ages. ADHD remained elevated across childhood and adolescence. Adenotonsillectomy was associated with lower risks of growth failure, delayed developmental milestones, and ADHD, whereas associations with obesity and precocious puberty were not evident.

CONCLUSIONS

Pediatric OSA is associated with sustained adverse outcomes across multiple domains of child health. Adenotonsillectomy may be associated with reduced risk of growth, developmental and neurobehavioral consequences. Early recognition and evaluation of pediatric OSA may therefore be important for improving long-term child health.