Obstructive sleep apnea and fractures in children and adolescents.

STUDY OBJECTIVES

To examine, among girls and boys, associations between site-specific extremity fracture and sleep apnea diagnosis or treatment.

METHODS

A cross-sectional analysis of claims data from 2016 to 2018 for children aged 2-18 years. Children with sleep apnea, continuous positive airway pressure, adenotonsillectomy, and fracture were identified using Current Procedural Terminology, and Healthcare Common Procedure Coding System codes. We examined sex-stratified associations between site-specific fracture, sleep apnea, and sleep apnea treatment.

RESULTS

Among 2,327,104 children, 9,547 (0.41%) had sleep apnea and nearly 61% were treated. Girls with sleep apnea, treated or untreated, had increased odds of lower, but not upper, extremity fracture compared to those without sleep apnea (treated 1.56, 95% confidence interval 1.11, 2.21; untreated odds ratio 1.63, 95% confidence interval 1.09, 2.44). Only boys untreated for sleep apnea had increased odds of lower extremity fracture in comparison to those without a diagnosis of sleep apnea (odds ratio 1.65, 95% confidence interval 1.20, 2.27). Interestingly, boys treated for sleep apnea but not those untreated, in comparison to boys without sleep apnea, had different (reduced) odds of upper extremity fracture (odds ratio 0.74, 95% confidence interval 0.59, 0.95).

CONCLUSIONS

These large datasets provide evidence that both boys and girls with untreated sleep apnea have higher odds of lower extremity fractures. However, treatment for sleep apnea was associated with improved odds of lower extremity fracture only in boys. Upper extremity data were less clear. These data are cross-sectional and cannot show causality, but they suggest that treatment for sleep apnea may lower risk for extremity fractures in boys.

CITATION

Matlen LB, Whitney DG, Whibley D, Jansen EC, Chervin RD, Dunietz GL. Obstructive sleep apnea and fractures in children and adolescents. . 2021;17(9):1853-1858.