Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Pediatric Pulmonary and Sleep Medicine, Children's National Medical Center, George Washington University, Washington, DC, USA.
Sleep. 2021 Dec 10;44(12). doi: 10.1093/sleep/zsab198.
Several birth cohorts have defined the pivotal role of early lower respiratory tract infections (LRTI) in the inception of pediatric respiratory conditions. However, the association between early LRTI and the development of obstructive sleep apnea (OSA) in children has not been established.
To investigate whether early LRTIs increase the risk of pediatric OSA, we analyzed clinical data in children followed during the first 5 years in the Boston Birth Cohort (n = 3114). Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariates were used to evaluate the risk of OSA by the age of 5 years between children with LRTI during the first 2 years of life in comparison to those without LRTI during this period.
Early life LRTI increased the risk of pediatric OSA independently of other pertinent covariates and risk factors (hazard ratio, 1.53; 95% CI, 1.15 to 2.05). Importantly, the association between LRTI and pediatric OSA was limited to LRTIs occurring during the first 2 years of life. Complementarily to this finding, we observed that children who had severe respiratory syncytial virus bronchiolitis during infancy had two times higher odds of OSA at 5 years in comparison with children without this exposure (odds ratio, 2.09; 95% CI, 1.12 to 3.88).
Children with severe LRTIs in early life have significantly increased risk of developing OSA during the first 5 years of life. Our results offer a new paradigm for investigating novel mechanisms and interventions targeting the early pathogenesis of OSA in the pediatric population.
有几个出生队列研究已经确定了早期下呼吸道感染（LRTI）在儿科呼吸道疾病发病中的关键作用。然而，早期 LRTI 与儿童阻塞性睡眠呼吸暂停（OSA）的发展之间的关联尚未确定。
为了研究早期 LRTI 是否会增加儿童 OSA 的风险，我们分析了在波士顿出生队列（n = 3114）中随访的儿童的临床数据。使用 Kaplan-Meier 生存估计和 Cox 比例风险模型，根据相关协变量进行调整，评估了在生命的前 5 年期间患有 LRTI 的儿童与在此期间无 LRTI 的儿童相比，5 岁时 OSA 的风险。
早期 LRTI 增加了儿科 OSA 的风险，独立于其他相关协变量和危险因素（风险比，1.53；95%置信区间，1.15 至 2.05）。重要的是，LRTI 与儿科 OSA 之间的关联仅限于生命的前 2 年发生的 LRTI。作为这一发现的补充，我们观察到，在婴儿期患有严重呼吸道合胞病毒毛细支气管炎的儿童，在 5 岁时患有 OSA 的几率是没有这种暴露的儿童的两倍（比值比，2.09；95%置信区间，1.12 至 3.88）。
在生命早期患有严重 LRTI 的儿童，在生命的前 5 年中发展为 OSA 的风险显著增加。我们的研究结果为研究儿科人群中 OSA 的早期发病机制的新机制和干预措施提供了新的范例。
