title: Pediatric sleep apnea and craniofacial anomalies: a population-based case-control study.
abstract: OBJECTIVE
  To investigate the association between craniofacial anomalies and diagnosis with obstructive sleep apnea (OSA) in a large, population-based sample of children.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Cases of OSA (n = 1,203) were identified by International Classification of Diseases-9 codes consistent with OSA in the 1987-2003 Washington State inpatient discharge database among children ≤18 years of age and born in Washington state. For each case, five controls without OSA (n = 6,015) were randomly selected from the remaining Washington State births, frequency matched by birth year. Congenital anomaly diagnoses and covariates were extracted from discharge data for all inpatient hospitalizations during the study period and linked birth certificate data. Multiple logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between congenital anomalies (including subgroups) and OSA.
  
  
  RESULTS
  An OSA diagnosis was strongly associated with the presence of any craniofacial anomaly (adjusted OR 38, 95%CI [24, 60]) and, in particular, with orofacial cleft (adjusted OR 40, 95%CI [17, 94]) and Down syndrome (adjusted OR 51, 95%CI [20, 128]). OSA was less associated with any noncraniofacial malformation (adjusted OR 4.1, 95%CI [3.1, 5.3]), which may reflect the relatively small effect of inpatient exposure bias in the associations above.
  
  
  CONCLUSIONS
  The presence of congenital craniofacial anomalies is strongly associated with inpatient diagnosis of OSA. These findings persist even after control of major potential biases. Parents and clinicians should consider screening for OSA among children with craniofacial anomalies.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington 98195, USA. derekjlam@gmail.com
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Lam
authors.forename: Christine C
authors.initials: CC
authors.lastname: Jensen
authors.forename: Beth A
authors.initials: BA
authors.lastname: Mueller
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Starr
authors.forename: Michael L
authors.initials: ML
authors.lastname: Cunningham
authors.forename: Edward M
authors.initials: EM
authors.lastname: Weaver
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D019465:Craniofacial Abnormalities / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
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