Clinical trial NCT04328402: Factors Correlated With Obstructive Sleep Apnea in Children and Adolescents
Official title: Factors Correlated With Obstructive Sleep Apnea in Children and Adolescents Diagnosed by Polysomnography: Cross-sectional Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Obstructive Sleep Apnea of Child
Keywords: diagnostic
polysomnography
sleep architecture
obstructive sleep apnea
Lead sponsor: Federal University of Pelotas
Sponsor class: OTHER
First posted: 2020-03-31
Enrollment: 187
Sex: ALL
Minimum age (years): 1
Maximum age (years): 18
Standard ages: CHILD
ADULT
Observational model: CASE_ONLY
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Participants in the child and adolescent age group, referred to the Pelotas Sleep Institute for polysomnography in the period from January 2012 to December 2017.

Brief summary: Obstructive Sleep Apnea (OSA) is a severe condition of sleep respiratory disorders. It is characterized by partial (hypopnea) or total (apnea) obstruction of the upper airways, negatively affecting the general and oral health of children and adolescents. The Dentistry plays a fundamental role in OSA diagnosis and early intervention, minimizing health damage and progression of the disease into adulthood. Current scientific evidence related to OSA and associated factors, as well as the prevalence and severity of the disease in children and adolescents is still scarce and presents divergences in these age groups. A retrospective cross-sectional study will be conducted to investigate the prevalence, severity and correlation between sociodemographic, behavioral, clinical and sleep quality related factors and OSA in children and adolescents diagnosed by polysomnography (PSG), using the criteria recommended by the American Academy of Sleep Medicine (AASM). The sample will consist of individuals who answered the questionnaires, performed the PSG at the Pelotas Sleep Institute and met the study inclusion criteria.

Detailed description: Obstructive Sleep Apnea (OSA) is a severe condition among sleep respiratory disorders, characterized by intermittent episodes of partial (hypopnea) or total (apnea) obstruction of the upper airways during sleep. These obstructive episodes result in hypoxemia and hypercapnia, changes in intrathoracic pressure and sleep arousals, consequently leading sleep fragmentation and a non-restorative sleep pattern.

OSA affects 1 to 4% of the world's pediatric population, with a higher incidence between 2 to 8 years old, negatively affecting the general and oral health of children and adolescents. Studies show divergences regarding the prevalence among sexes, either showing similar rates for girls and boys, or a predilection of the disease for the male sex. Although scientific evidence reports known OSAs risk factors like adenotonsilar hypertrophy and obesity, there is still divergence of which associated characteristics are present in children and adolescents.

Diagnostic criteria of OSA in this population follows the recommendations of American Academy of Sleep Medicine (AASM) through the International Classification of Sleep Disorders (ICSD-3), which determines full-night PSG as the gold standard test for the diagnosis and severity of OSA, as it promotes a quantitative and objective assessment of disturbances in breathing and sleep patterns. Although parents' report of child behavior and symptoms is essential for establishing the diagnosis of OSA, the factors evaluated in the anamnesis and clinical examination, in general, do not present adequate accuracy for the diagnosis of OSA. The use of clinical history and physical examination alone is not suitable for a definite diagnose of OSA when compared to PSG. Besides, most questionnaires used as alternative diagnostic methods do not meet the necessary criteria to be considered as acceptable tools in the identification of children and adolescents with OSA.

There is evidence in the literature regarding OSA's significant morbidity in children and adolescents, leading to cardiovascular, metabolic and neurocognitive complications, resulting in reduced quality of life. Also, OSA is associated with several craniofacial and dental changes, such as retrognathia, class II malocclusion, vertical face growth and sleep bruxism. It becomes clear the importance of the dentist in identifying factors associated with OSA in children and adolescents, this being the first step towards early and definitive diagnosis, followed by adequate treatment, to minimize the health damage in this population. Therefore, this study aims to study the risk factors correlated with OSA, the prevalence and severity of illness in children and adolescents, considering that the current scientific evidence is divergent.

A retrospective cross-sectional study will be conducted to investigate the prevalence, severity and associations between diagnosis by gold-standard PSG examination and the sociodemographic, clinical conditions, sleep quality and sleep structure of children and adolescents, following the recommended criteria by the AASM. Also, this study aims to evaluate the association of sleep bruxism (SB) and OSA. The sample will consist of participants, between 1 and 18 years, who were referred to Pelotas Sleep Institute, answered the questionnaires (self-reported or parent-reported) and performed PSG for diagnostic purposes.

Eligibility criteria: Inclusion Criteria:

* Children (1 to 11 years) and adolescents (12 to 18 years), who were referred to a sleep laboratory
* Participants who performed polysomnography and answered questionnaires (self-reported or parent-reported) at Pelotas Sleep Institute.

Exclusion Criteria:

* Participants who present a history of syndromes, neuromuscular or neurological disorders;
* Participants whose questionnaires were not completed.

Primary outcomes:
measure: Prevalence and severity of Obstructive Sleep Apnea (OSA) in children and adolescents evaluated by polysomnography
timeFrame: day 1
Secondary outcomes:
measure: Sociodemographic and clinical condition variables
timeFrame: day 1
measure: Sleep quality variables
timeFrame: day 1
measure: Sleep structure variables
timeFrame: day 1
measure: Sleep Bruxism detection
timeFrame: day 1
Other outcomes:
Locations:
city: Pelotas
country: Brazil
facility: Federal University of Pelotas
state: RS
Study officials:
affiliation: Federal University of Pelotas
name: Noéli Boscato, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Garg RK, Afifi AM, Garland CB, Sanchez R, Mount DL. Pediatric Obstructive Sleep Apnea: Consensus, Controversy, and Craniofacial Considerations. Plast Reconstr Surg. 2017 Nov;140(5):987-997. doi: 10.1097/PRS.0000000000003752.
citation: Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016 Jan;47(1):69-94. doi: 10.1183/13993003.00385-2015. Epub 2015 Nov 5.
citation: Tan HL, Gozal D, Kheirandish-Gozal L. Obstructive sleep apnea in children: a critical update. Nat Sci Sleep. 2013 Sep 25;5:109-23. doi: 10.2147/NSS.S51907.
citation: Baidas L, Al-Jobair A, Al-Kawari H, AlShehri A, Al-Madani S, Al-Balbeesi H. Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children. BMC Oral Health. 2019 Mar 12;19(1):43. doi: 10.1186/s12903-019-0735-3.
citation: Andersen IG, Holm JC, Homoe P. Obstructive sleep apnea in children and adolescents with and without obesity. Eur Arch Otorhinolaryngol. 2019 Mar;276(3):871-878. doi: 10.1007/s00405-019-05290-2. Epub 2019 Jan 28.
citation: Baker M, Scott B, Johnson RF, Mitchell RB. Predictors of Obstructive Sleep Apnea Severity in Adolescents. JAMA Otolaryngol Head Neck Surg. 2017 May 1;143(5):494-499. doi: 10.1001/jamaoto.2016.4130.
citation: Chen T, Hughes ME, Wang H, Wang G, Hong X, Liu L, Ji Y, Pearson C, Li S, Hao L, Wang X. Prenatal, Perinatal, and Early Childhood Factors Associated with Childhood Obstructive Sleep Apnea. J Pediatr. 2019 Sep;212:20-27.e10. doi: 10.1016/j.jpeds.2019.05.053. Epub 2019 Jun 26.
citation: Sanchez T, Rojas C, Casals M, Bennett JT, Galvez C, Betancur C, Mesa JT, Brockmann PE. [Prevalence and risk factors for sleep-disordered breathing in chilean schoolchildren]. Rev Chil Pediatr. 2018 Dec;89(6):718-725. doi: 10.4067/S0370-41062018005000902. Spanish.
citation: Krzeski A, Burghard M. Obstructive sleep disordered breathing in children - an important problem in the light of current European guidelines. Otolaryngol Pol. 2018 Jun 29;72(5):9-16. doi: 10.5604/01.3001.0012.1570.
citation: Goyal M, Johnson J. Obstructive Sleep Apnea Diagnosis and Management. Mo Med. 2017 Mar-Apr;114(2):120-124.
citation: Certal V, Catumbela E, Winck JC, Azevedo I, Teixeira-Pinto A, Costa-Pereira A. Clinical assessment of pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2012 Sep;122(9):2105-14. doi: 10.1002/lary.23465. Epub 2012 Aug 9.
citation: Brietzke SE, Katz ES, Roberson DW. Can history and physical examination reliably diagnose pediatric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature. Otolaryngol Head Neck Surg. 2004 Dec;131(6):827-32. doi: 10.1016/j.otohns.2004.07.002.
citation: Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010 May;57(5):423-38. doi: 10.1007/s12630-010-9280-x. Epub 2010 Feb 9.
citation: De Luca Canto G, Singh V, Major MP, Witmans M, El-Hakim H, Major PW, Flores-Mir C. Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children: a systematic review and meta-analysis. J Am Dent Assoc. 2014 Feb;145(2):165-78. doi: 10.14219/jada.2013.26.
citation: Pabla L, Duffin J, Flood L, Blackmore K. Paediatric obstructive sleep apnoea: can our identification of surgical candidates be evidence-based? J Laryngol Otol. 2018 Apr;132(4):284-292. doi: 10.1017/S0022215118000208. Epub 2018 Feb 14.