Severe Obstructive Sleep Apnea Hits Inner-City Children the Hardest

Dentistry Today


Pediatric severe obstructive sleep apnea (OSA) is most common among inner-city African-American children from low-income families in the Washington, DC, metropolitan area, according to the Children’s National Health System (CNHS). The organization’s researchers also have found that these children were most likely to have delayed diagnosis of severe OSA. 

“Earlier studies have shown that OSA is more prevalent among inner-city children,” said lead author Sasikumar Kilaikode, MD. “We wanted to see if this was the case in Washington, DC, as we have a large inner-city minority population. We also wanted to address the lack of data on the characteristics of severe OSA in inner-city children and adolescents.” 

OSA affects 3% of all children in the United States, impairing their ability to function in school and potentially leading to other significant health issues such as high blood pressure, heart disease, and diabetes. Severe OSA is defined as 10 or more events per hour in which the patient stops breathing, as measured in an initial sleep study.

The researchers looked at the medical records of 150 severe OSA patients seen in the CNHS Pediatric Sleep Center as well as their demographic variables, including where they live, their race and ethnicity, and their socioeconomic status. The vast majority of severe OSA patients were identified as African-American.

Also, African-American children had a 2-year median duration of symptoms before being diagnosed, or double that of white children. The regions with the most severe cases of OSA were those with the largest proportion of low-income and minority children: Prince George County, Md, and neighborhoods of Washington, DC, with the highest poverty levels.

“We have demonstrated that there is a critical need to focus care, resources, and education to identify and treat pediatric OSA in minority communities of inner-city areas. These children may be at the highest risk for severe OSA due to premature birth and a high prevalence of asthma and allergies. Lack of awareness at the family level delays reporting of symptoms and ultimately leads to delayed diagnosis,” said Kilaikode.

Pediatric dentists have a role in improving diagnosis and treatment, and they are an important part of the team in managing OSA in children, Kilaikode explained. For example, dentists can screen for symptoms such as snoring, gasping arousals, and observed apnea. Also, they can perform careful physical examinations of the oral and facial areas of children with positive symptoms.

“Our study and previous studies report that craniofacial abnormalities are an important cause of sleep apnea in children. So, dentists have an important role in identifying any structural abnormalities causing obstructions to breathing during sleep,” Kilaikode said. “Also, studies have been in progress about the use of dental appliances in the treatment of sleep apnea in children with dental or facial abnormalities contributing to the obstruction.”

Furthermore, dentists can encourage families to observe their children for sleep disordered breathing and report them early, she said. When positive symptoms are found, dentists can refer these children to a pediatric sleep center, where they can be evaluated and diagnosed with an overnight polysomnography, or sleep study. Early diagnosis and treatment may prevent unwanted complications in children, including neuro-cognitive impairment. 

“Our future directions include identifying barriers to timely diagnosis and early referral. We envision area-focused education and awareness for observing and reporting symptoms of OSA in children,” she said. “Our future plans also include providing awareness at the primary health provider level and reinforcing mandatory screening for symptoms of OSA during well-child visits. In addition, we plan to develop school and community based education initiatives.”

The results of the study were presented at the 2017 American Thoracic Society International Conference in Washington, DC.

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