Greater risk of hospitalization in children with down syndrome and OSA at higher elevation

Kristin M. Jensen, Carter J. Sevick, Laura A S Seewald, Ann C. Halbower, Matthew M. Davis, Edward R B McCabe, Allison Kempe, Steven H. Abman

Research output: Contribution to journalArticle

Abstract

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 diff erences 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 diff erence 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, 2 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. Th is fi nding has not been described previously. With further validation, this fi nding suggests the need for greater awareness and earlier screening for OSA and its complications in patients with DS living at higher elevations.

Original languageEnglish (US)
Pages (from-to)1344-1351
Number of pages8
JournalChest
Volume147
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Down Syndrome
Hospitalization
Heart Diseases
Pneumonia
Comorbidity
Inpatients
Logistic Models
Databases
Pediatrics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Jensen, K. M., Sevick, C. J., Seewald, L. A. S., Halbower, A. C., Davis, M. M., McCabe, E. R. B., ... Abman, S. H. (2015). Greater risk of hospitalization in children with down syndrome and OSA at higher elevation. Chest, 147(5), 1344-1351. https://doi.org/10.1378/chest.14-1883

Greater risk of hospitalization in children with down syndrome and OSA at higher elevation. / Jensen, Kristin M.; Sevick, Carter J.; Seewald, Laura A S; Halbower, Ann C.; Davis, Matthew M.; McCabe, Edward R B; Kempe, Allison; Abman, Steven H.

In: Chest, Vol. 147, No. 5, 01.05.2015, p. 1344-1351.

Research output: Contribution to journalArticle

Jensen, KM, Sevick, CJ, Seewald, LAS, Halbower, AC, Davis, MM, McCabe, ERB, Kempe, A & Abman, SH 2015, 'Greater risk of hospitalization in children with down syndrome and OSA at higher elevation', Chest, vol. 147, no. 5, pp. 1344-1351. https://doi.org/10.1378/chest.14-1883
Jensen KM, Sevick CJ, Seewald LAS, Halbower AC, Davis MM, McCabe ERB et al. Greater risk of hospitalization in children with down syndrome and OSA at higher elevation. Chest. 2015 May 1;147(5):1344-1351. https://doi.org/10.1378/chest.14-1883
Jensen, Kristin M. ; Sevick, Carter J. ; Seewald, Laura A S ; Halbower, Ann C. ; Davis, Matthew M. ; McCabe, Edward R B ; Kempe, Allison ; Abman, Steven H. / Greater risk of hospitalization in children with down syndrome and OSA at higher elevation. In: Chest. 2015 ; Vol. 147, No. 5. pp. 1344-1351.
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abstract = "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 diff erences 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 diff erence 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, 2 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. Th is fi nding has not been described previously. With further validation, this fi nding suggests the need for greater awareness and earlier screening for OSA and its complications in patients with DS living at higher elevations.",
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T1 - Greater risk of hospitalization in children with down syndrome and OSA at higher elevation

AU - Jensen, Kristin M.

AU - Sevick, Carter J.

AU - Seewald, Laura A S

AU - Halbower, Ann C.

AU - Davis, Matthew M.

AU - McCabe, Edward R B

AU - Kempe, Allison

AU - Abman, Steven H.

PY - 2015/5/1

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N2 - 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 diff erences 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 diff erence 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, 2 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. Th is fi nding has not been described previously. With further validation, this fi nding suggests the need for greater awareness and earlier screening for OSA and its complications in patients with DS living at higher elevations.

AB - 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 diff erences 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 diff erence 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, 2 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. Th is fi nding has not been described previously. With further validation, this fi nding suggests the need for greater awareness and earlier screening for OSA and its complications in patients with DS living at higher elevations.

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