STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with cardiovascular and cerebrovascular morbidity. Patients with sickle cell disease (SCD) are at increased risk for both neurologic complications (NC) and OSA. However, the relationship between OSA and SCD complications is unclear. We hypothesized that there would be an association between OSA diagnosis and SCD complications. METHODS Hospital discharge records of patients with SCD aged & 19 years were obtained for the years 1997, 2000, 2003, 2006, 2009, and 2012 from the Kid's Inpatient Database. The primary outcome, NC, a composite of stroke, transient ischemic attack and seizures. Secondary outcomes included acute chest syndrome (ACS), vaso-occlusive crisis, length of hospital stay, and inflation-adjusted cost of hospitalization. Multivariable regression was conducted to ascertain the association of OSA with primary and secondary outcomes. Analyses were adjusted for the use of non-invasive mechanical ventilation (NIMV) to determine its role as NC risk modifier. RESULTS There were 203,705 SCD discharges included in the analysis, of which 2,820 (1.4%) and 4,447 (2.2%) also included OSA and NC diagnoses. Multivariable logistic regression indicated that OSA was associated with NC (adjusted odds ratio [OR], 1.50 [95% CI 1.02-2.21], p=0.039), and ACS (OR, 1.34 [95% CI 1.08-1.67], p=0.009) in children with SCD. In the multivariable analysis adjusted for NIMV, the significant association between OSA and NC was no longer observed (OR, 1.39 [95% CI 0.94-2.05], p=0.100). CONCLUSION OSA is associated with 50% increase of odds of NC in children with SCD in this nationwide dataset. The use of NIMV to treat OSA may modify the risk of OSA-associated NC.

中文翻译：

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儿童镰状细胞病阻塞性睡眠呼吸暂停的负担：儿童住院数据库研究

研究目标 阻塞性睡眠呼吸暂停 (OSA) 与心血管和脑血管的发病率有关。镰状细胞病 (SCD) 患者发生神经系统并发症 (NC) 和 OSA 的风险均增加。然而，OSA 和 SCD 并发症之间的关系尚不清楚。我们假设 OSA 诊断与 SCD 并发症之间存在关联。方法 从儿童住院数据库中获取 1997、2000、2003、2006、2009 和 2012 年 19 岁和 19 岁 SCD 患者的出院记录。主要结果，NC，中风、短暂性脑缺血发作和癫痫发作的复合。次要结局包括急性胸部综合征 (ACS)、血管闭塞危象、住院时间和通货膨胀调整后的住院费用。进行多变量回归以确定 OSA 与主要和次要结果的关联。针对无创机械通气 (NIMV) 的使用对分析进行了调整，以确定其作为 NC 风险调节剂的作用。结果 分析中包括 203,705 例 SCD 放电，其中 2,820 (1.4%) 和 4,447 (2.2%) 还包括 OSA 和 NC 诊断。多变量逻辑回归表明 OSA 与 NC（调整比值比 [OR]，1.50 [95% CI 1.02-2.21]，p=0.039）和 ACS（OR，1.34 [95% CI 1.08-1.67]，p= 0.009) 在患有 SCD 的儿童中。在针对 NIMV 调整的多变量分析中，不再观察到 OSA 和 NC 之间的显着关联（OR，1.39 [95% CI 0.94-2.05]，p=0.100）。结论 在这个全国性数据集中，OSA 与 SCD 儿童的 NC 几率增加 50% 相关。