title: Comorbidities in infants with obstructive sleep apnea.
abstract: OBJECTIVE
  The clinical characteristics of obstructive sleep apnea (OSA) in infants have been insufficiently characterized. Our aim was to describe identifiable comorbidities in infants with obstructive sleep apnea, which may assist in recognizing these patients earlier in their disease course and help improve management.
  
  
  METHODS
  This was a single-center, retrospective study involving infants 0-17 months of age with a diagnosis of OSA on the basis of clinical features and nocturnal polysomnography (PSG) at the Mayo Clinic Center for Sleep Medicine between 2000 and 2011. Patients were excluded if they had central apnea accounting for greater than 50% of respiratory events. OSA severity was determined by the apnea-hypopnea index (AHI).
  
  
  RESULTS
  One hundred thirty-nine patients were included. Based upon the AHI, they were subdivided into mild (AHI <5; 30%), moderate (AHI 5-9; 30%), or severe (AHI >10; 40%) categories. Comorbidities included gastroesophageal reflux in 95/139 (68%), periodic limb movements in sleep in 59/139 (42%), craniofacial abnormalities in 52/139 (37%), neuromuscular abnormalities in 47/139 (34%), prematurity in 41/139 (29%), genetic syndromes in 41/139 (29%), laryngomalacia / tracheomalacia in 38/139 (27%), and epilepsy in 23/139 (17%) of subjects. Severity of OSA correlated with prematurity, having a genetic syndrome, or neuromuscular abnormality. Multispecialty evaluation was needed for 119/139 (86%).
  
  
  CONCLUSIONS
  Comorbidities in infants with OSA differ from those of older children. Based upon the comorbidities identified in our study population, it appears that appropriate management of infants with OSA requires a multidisciplinary approach involving genetics, gastroenterology, pulmonology, otolaryngology, neurology, and general pediatrics.
authors.affiliation: Division of Child Neurology, Mayo Clinic, Rochester, MN.
authors.forename: William F
authors.initials: WF
authors.lastname: Qubty
authors.affiliation: Division of Child Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Anna
authors.initials: A
authors.lastname: Mrelashvili
authors.affiliation: Division of Child Neurology, Mayo Clinic, Rochester, MN and Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Suresh
authors.initials: S
authors.lastname: Kotagal
authors.affiliation: Division of Pediatrics, Mayo Clinic, Rochester, MN and Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Lloyd
mesh_terms: D017677:Age Distribution; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends*; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology; D019465:Craniofacial Abnormalities / Q000175:diagnosis / Q000453:epidemiology; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009468:Neuromuscular Diseases / Q000175:diagnosis / Q000453:epidemiology; D017286:Polysomnography / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000453:epidemiology*; D055090:Tracheomalacia / Q000175:diagnosis / Q000453:epidemiology
keywords: Infant; obstructive sleep apnea; polysomnography; sleep disordered breathing; sleep disorders