0
Original Research: Sleep Disorders |

Greater Risk of Hospitalization in Children With Down Syndrome and OSA at Higher ElevationDown Syndrome and OSA at Elevation

Kristin M. Jensen, MD; Carter J. Sevick, MS; Laura A. S. Seewald, BA; Ann C. Halbower, MD; Matthew M. Davis, MD, MAPP; Edward R. B. McCabe, MD, PhD; Allison Kempe, MD, MPH; Steven H. Abman, MD
Author and Funding Information

From the Children’s Outcomes Research Program (Drs Jensen and Kempe and Mr Sevick), Breathing Institute (Dr Halbower), Pediatric Heart Lung Center (Dr Abman), Department of Pediatrics (Drs Jensen and Halbower), Department of Internal Medicine (Dr Jensen), and Linda Crnic Institute for Down Syndrome (Ms Seewald), University of Colorado School of Medicine, Aurora, CO; Child Health Evaluation and Research Unit (Dr Davis), University of Michigan Health System, Ann Arbor, MI; Institute for Healthcare Policy and Innovation and Gerald R. Ford School of Public Policy (Dr Davis), University of Michigan, Ann Arbor, MI; and the Department of Medical Affairs, Office of Medicine and Health Promotion (Dr McCabe), March of Dimes Foundation, White Plains, NY.

CORRESPONDENCE TO: Kristin M. Jensen, MD, Departments of Pediatrics and Internal Medicine, University of Colorado School of Medicine, 13199 E Montview Blvd, Ste 300, Mailstop F-443, Aurora, CO 80045; e-mail: kristin.jensen@ucdenver.edu


Preliminary data from this analysis were presented by Dr Jensen at the Pediatric Academic Societies Meeting, April 28-May 1, 2012, Boston, MA.

FUNDING/SUPPORT: This study was funded in part by the Robert Wood Johnson Foundation Clinical Scholars Program and in part through gift funds provided by the Anna and John J. Sie Foundation and the Global Down Syndrome Foundation to the Linda Crnic Institute for Down Syndrome.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1344-1351. doi:10.1378/chest.14-1883
Text Size: A A A
Published online

BACKGROUND:  Children with Down syndrome (DS) are at high risk for OSA. Increasing elevation is known to exacerbate underlying respiratory disorders and worsen sleep quality in people without DS, but whether altitude modulates the severity of OSA in DS is uncertain. In this study, we evaluate the impact of elevation (≤ 1,500 m vs > 1,500 m) on the proportion of hospitalizations involving OSA in children with and without DS.

METHODS:  Merging the 2009 Kids’ Inpatient Database with zip-code linked elevation data, we analyzed differences in the proportion of pediatric hospitalizations (ages 2-20 years) involving OSA, pneumonia, and congenital heart disease (CHD), with and without DS. We used multivariable logistic regression to evaluate the association of elevation with hospitalizations involving OSA and DS, adjusting for key comorbidities.

RESULTS:  Proportionately more DS encounters involved OSA, CHD, and pneumonia within each elevation category than non-DS encounters. However, the risk difference for hospitalizations involving OSA and DS increased disproportionately at higher elevations (DS: 16.2% [95% CI, 9.2%-23.2%]; non-DS: 0.1% [95% CI, −0.4% to 0.7%]). Multivariable estimates of relative risk indicate increased risk for hospitalization involving OSA at higher elevations for people with DS and in children aged 2 to 4 years or with two or more chronic conditions.

CONCLUSIONS:  At elevations > 1,500 m, children with DS and OSA have a disproportionately higher risk for hospitalization than children with OSA without DS. This finding has not been described previously. With further validation, this finding suggests the need for greater awareness and earlier screening for OSA and its complications in patients with DS living at higher elevations.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543