Obstructive Sleep Apnea in Children Under 3 Years of Age

Objective: To identify predictors of severe obstructive sleep apnea (OSA) in children under 3 years of age and to compare demographics, comorbidities, and polysomnographic characteristics of infants and toddlers with OSA. Study Design: Retrospective case series. Methods: We examined children under 3 years of age who had polysomnogram between August 2012 and March 2020. Demographics, clinical, and polysomnographic parameters were compared in children age 0–1 versus 1–3 years and 0–2 versus 2–3 years and severe versus mild–moderate OSA. Univariate analysis was used to compare age groups; multiple logistic regression for predictors of severe OSA. Significance was set at P <.05. Results: Of the 413 children, 267 (65%) were male and 131 (32%) obese. The population included Hispanic (41%), African American (28%), and Caucasian (25%) children. A total of 98.5% had OSA and 35% had severe OSA. Children under 1 year of age more commonly had gastroesophageal reflux disease (GERD) (38% vs. 23%; P =.014); tonsillar hypertrophy was more common in children over 2 years of age (56% vs. 34%, P =.001). Down syndrome (odds ratio (OR): 3.16, 95% confidence interval (CI) = 1.14–8.68, P =.026) and tonsillar hypertrophy (OR: 1.97, 95% CI = 1.28–3.02, P =.002) were predictors of severe OSA. Conclusion: Children under 3 years of age with OSA are more likely to be male and have GERD. Down syndrome and tonsillar hypertrophy are predictors of severe OSA, and children with these conditions should be prioritized for polysomnography. Level of Evidence: 4 Laryngoscope, 131:E2603–E2608, 2021.