Study Objectives 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. Methods 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. Results 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). Conclusions 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.

中文翻译：

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在大量出生队列中，生命早期的下呼吸道感染与儿童时期阻塞性睡眠呼吸暂停的诊断相关

研究目标 几个出生队列已经明确了早期下呼吸道感染 (LRTI) 在儿科呼吸道疾病发生过程中的关键作用。然而，早期 LRTI 与儿童阻塞性睡眠呼吸暂停 (OSA) 发展之间的关联尚未确定。方法 为了调查早期 LRTI 是否会增加儿科 OSA 的风险，我们分析了波士顿出生队列 (n = 3114) 中前 5 年随访儿童的临床数据。使用 Kaplan-Meier 生存估计和经相关协变量调整的 Cox 比例风险模型来评估生命前 2 年内患有 LRTI 的儿童与在此期间没有 LRTI 的儿童相比，5 岁时 OSA 的风险。结果 生命早期 LRTI 会增加儿科 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% CI，1.15 至 2.05）。重要的是，LRTI 和儿科 OSA 之间的关联仅限于生命最初 2 年内发生的 LRTI。与这一发现相补充的是，我们观察到，婴儿期患有严重呼吸道合胞病毒细支气管炎的儿童在 5 岁时患 OSA 的几率是没有接触过这种病毒的儿童的两倍（比值比，2.09；95% CI，1.12 至 3.88）。结论 早年患有严重 LRTI 的儿童在生命的前 5 年内患 OSA 的风险显着增加。我们的结果为研究针对儿科人群 OSA 早期发病机制的新机制和干预措施提供了新的范例。