Pathophysiological Traits in Pediatric Obstructive Sleep Apnea. Associations with Patient Characteristics and Responses to Therapy: A Secondary Analysis of CHAT Clinical Trial
Abstract
RATIONALE
In children with adenotonsillar hypertrophy, there is substantial variation in pediatric obstructive sleep apnea (pOSA) severity, which may be driven by differences in pathophysiological traits (endotypes) including pharyngeal collapsibility, dilator muscle compensation, arousal threshold, and chemoreflex loop gain. Objective (s): To determine if pathophysiological traits for pOSA vary with participant characteristics, correlate with pOSA severity, and change after adenotonsillectomy.
METHODS
Traits estimation, requiring adequate nasal pressure data quality, were performed during sleep (primary analysis in REM) from baseline polysomnography (N=1117; age 6.9±1.5 y; BMI-z 0.89±1.23; total AHI 5.1±9.1 events/hr; REM-AHI 11.0±20.1 events/hr) and post-intervention polysomnography (N=360; adenotonsillectomy or watchful waiting). Associations of each endotype (per SD) with AHI and with patient characteristics (race/ethnicity, age, sex, and BMI-z) were characterized using multivariable regression. The effects of adenotonsillectomy on AHI and endotypes were also examined.
RESULTS
The sample was comprised of 52% females and children from diverse racial and ethnic backgrounds and geographic sites. Higher REM-AHI was observed in Black (7.81±1.01, βadjusted±SEM, events/hour) and Asian (9.37±3.35) compared to White children; these differences were accompanied by greater collapsibility (0.30±0.09 per SD) in Black children and decreased compensation (-0.99±0.20) in Asian children.…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,117 participants or records.
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