Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Pediatr. 2019 Sep;212:20-27.e10. doi: 10.1016/j.jpeds.2019.05.053. Epub 2019 Jun 26.
To investigate prenatal, perinatal, and early childhood factors, including cord and early childhood plasma leptin, on a clinical diagnosis of obstructive sleep apnea (OSA) among children in the Boston Birth Cohort.
We conducted a secondary analysis of 2867 mother-child pairs from the Boston Birth Cohort who were enrolled between 1998 and 2014 at Boston Medical Center and followed from birth to age 16 years. Child's OSA was defined based on clinical diagnoses documented in the medical record. Plasma leptin was measured in cord and early childhood blood samples. Logistic regression was used to examine individual and combined effects of early life factors on the risk of OSA, adjusting for potential confounders.
The mean age of the study children was 6.39 years (SD = 3.77); 49.3% were girls, and 209 (7.3%) had ever been diagnosed with OSA. Four significant risk factors for OSA were identified: maternal obesity/diabetes during pregnancy (OR, 1.63; 95% CI, 1.21-2.21; P = .001), preterm/low birth weight (OR, 1.74; 95% CI, 1.30-2.32; P < .001), early childhood obesity (OR, 1.89; 95% CI, 1.37-2.62; P < .001), and high leptin levels in early childhood (OR, 1.94; 95% CI, 1.22-3.09; P = .005). The presence of all these 4 risk factors significantly amplified the odds of OSA by about 10 times (OR, 9.95; 95% CI, 3.42-28.93; P < .001) compared with those lacking these factors.
Our findings, if further confirmed, provide new insight into the early life risk factors of pediatric OSA and underscore the need for early screening and prevention of OSA among children with those risk factors.
在波士顿出生队列中，通过对包括脐带和儿童早期血浆瘦素在内的产前、围产期和儿童早期因素进行研究，来调查儿童阻塞性睡眠呼吸暂停（OSA）的临床诊断。
我们对参加了 1998 年至 2014 年在波士顿医疗中心的波士顿出生队列的 2867 对母婴对进行了二次分析，并对其进行了随访，随访时间从出生到 16 岁。儿童 OSA 是根据病历中记录的临床诊断来定义的。在脐带和儿童早期的血液样本中测量血浆瘦素。使用逻辑回归检查了早期生活因素对 OSA 风险的个体和综合影响，同时调整了潜在的混杂因素。
研究儿童的平均年龄为 6.39 岁（标准差=3.77）；49.3%为女孩，209 人（7.3%）曾被诊断患有 OSA。有四个显著的 OSA 风险因素被确定：母亲在怀孕期间肥胖/糖尿病（OR，1.63；95%CI，1.21-2.21；P=0.001）、早产/低出生体重（OR，1.74；95%CI，1.30-2.32；P<0.001）、儿童早期肥胖（OR，1.89；95%CI，1.37-2.62；P<0.001）和儿童早期高瘦素水平（OR，1.94；95%CI，1.22-3.09；P=0.005）。这些 4 个风险因素的存在使 OSA 的可能性增加了近 10 倍（OR，9.95；95%CI，3.42-28.93；P<0.001），与那些缺乏这些因素的儿童相比。
如果进一步证实，我们的发现为儿科 OSA 的早期生活风险因素提供了新的见解，并强调需要对具有这些风险因素的儿童进行 OSA 的早期筛查和预防。
