Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington 98195, USA.
Laryngoscope. 2010 Oct;120(10):2098-105. doi: 10.1002/lary.21093.
To investigate the association between craniofacial anomalies and diagnosis with obstructive sleep apnea (OSA) in a large, population-based sample of children.
Retrospective case-control study.
Cases of OSA (n = 1,203) were identified by International Classification of Diseases-9 codes consistent with OSA in the 1987-2003 Washington State inpatient discharge database among children ≤18 years of age and born in Washington state. For each case, five controls without OSA (n = 6,015) were randomly selected from the remaining Washington State births, frequency matched by birth year. Congenital anomaly diagnoses and covariates were extracted from discharge data for all inpatient hospitalizations during the study period and linked birth certificate data. Multiple logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between congenital anomalies (including subgroups) and OSA.
An OSA diagnosis was strongly associated with the presence of any craniofacial anomaly (adjusted OR 38, 95%CI [24, 60]) and, in particular, with orofacial cleft (adjusted OR 40, 95%CI [17, 94]) and Down syndrome (adjusted OR 51, 95%CI [20, 128]). OSA was less associated with any noncraniofacial malformation (adjusted OR 4.1, 95%CI [3.1, 5.3]), which may reflect the relatively small effect of inpatient exposure bias in the associations above.
The presence of congenital craniofacial anomalies is strongly associated with inpatient diagnosis of OSA. These findings persist even after control of major potential biases. Parents and clinicians should consider screening for OSA among children with craniofacial anomalies.
在一个大型的基于人群的儿童样本中，调查颅面畸形与阻塞性睡眠呼吸暂停（OSA）诊断之间的关系。
回顾性病例对照研究。
通过 1987-2003 年华盛顿州住院病人出院数据库中与 OSA 一致的国际疾病分类第 9 版代码，确定 OSA 病例（n=1203），病例为年龄≤18 岁且出生于华盛顿州的儿童。对于每个病例，从剩余的华盛顿州出生的人群中随机选择 5 名无 OSA 的对照（n=6015），按出生年份进行频数匹配。从所有住院患者的出院数据中提取先天性异常诊断和协变量，并与出生证明数据链接。采用多因素逻辑回归计算先天性异常（包括亚组）与 OSA 之间的关联的调整比值比（OR）和 95%置信区间（CI）。
OSA 诊断与任何颅面畸形（调整 OR 38，95%CI [24, 60]），特别是口面裂（调整 OR 40，95%CI [17, 94]）和唐氏综合征（调整 OR 51，95%CI [20, 128]）存在显著关联。OSA 与任何非颅面畸形的相关性较低（调整 OR 4.1，95%CI [3.1, 5.3]），这可能反映了上述关联中住院暴露偏倚的影响相对较小。
先天性颅面畸形的存在与 OSA 的住院诊断密切相关。即使在控制了主要潜在偏倚后，这些发现仍然存在。父母和临床医生应考虑对颅面畸形儿童进行 OSA 筛查。
