Distribution Characteristics And Influencing Factors Of Central Apnea In Pediatric Patients With Obstructive Sleep Apnea (OSA)

Objective:Pediatric obstructive sleep apnea(OSA)respiratory events are mainly obstructive,but in clinical practice,children with OSA also have central apnea events,and the central apnea index(CAI)is higher than the obstructive apnea and hypopnea index(OAHI).Few studies have focused on the importance of central apnea events in children with OSA.This study analyzed the PSG reports and aimed to elucidate the distribution characteristics and major factors associated with central apnea in pediatric OSA.Methods:A retrospective analysis of the data of children who underwent PSG examination at the Children’s Hospital of Capital Institute of Pediatrics from January 2017 to March 2018 due to snoring.According to OAHI,patients were divided into the mild group(1≤OAHI<5),moderate group(5<OAHI<10),and severe group(OAHI>10),and the differences in demographics and sleep parameters of children with mild,moderate,and severe OSA were compared;the distribution characteristics of CAI were analyzed.The influencing factors of CAI in children with OSA were evaluated by correlation analysis and regression analysis.Results:Data were available from 856 children,317/856 girls,and 539/856 boys,the average age was 4.9±2.4 years old.There were 374 cases of mild,261 cases of moderate,and 221 cases of severe.There was no significant difference in gender and SWS phase among different groups.The moderate and severe group had higher CAI,lower Minimum oxygen saturation(Min Sat)and higher oxygen desaturation index(ODI)than that of the mild group.50.1%(429/856)had a CAI>1,and 2.9%(25/856)had a CAI>5.The range of CAI was 0～11.1,the median was 1.1;the range of OAHI was 1～85.7,the median was 5.8.According to CAI,the children were divided into two groups:CAI≤1 group and CAI>1 group.Children with a CAI>1 had a higher OAHI,arousal index(AI),ODI,and a longer REM period,but a younger age and a shorter SWS phase.Associations between the CAI and potential possible influencing factors were evaluated by Spearman rank-order correlation analysis,CAI was positively correlated with sex,AI,OAHI,OAI,ODI,and REM.CAI was negatively correlated with age,minimum oxygen saturation,and SWS stage.In univariate binary logistic regression analysis(CAI>1 is the outcome variable),age,male,and S WS period are protective factors,while OAHI,AI,OAI,and REM periods are risk factors.ODI and MinSat have no significant effect on CAI.Multivariate binary logistic regression showed that with a 1%increased REM period,the risk of the CAI being>1 increased by 5.3%(p<0.001).The CAI increased with an increasing OAHI(p=0.003).The possibility of a CAI ≤1 increased with age(p<0.001),and boys were more likely to have a CAI ≤1(p=0.001).Conclusions:In addition to obstructive apnea(OA),almost all children with OS A also had CA,and a CAI>1 was most likely to occur.The OAHI and REM period were risk factors for an increased CAI,and age and male sex were protective factors.