Association of Childhood Asthma and Pediatric Obstructive Sleep Apnea: A Retrospective Cohort Study from a Nationwide Population-based Database

Abstract

Background and objective: Asthma is a risk factor for obstructive sleep apnea (OSA) in adult patients. However, the relationship between pediatric OSA and childhood asthma remains unclear. Here, we conducted a large-scale population-based cohort study for evaluating our hypothesis that childhood asthma is a risk factor for pediatric OSA. Methods: From 2000 to 2007, children with and without asthma who were frequency matched by age, sex, urbanization level, comorbidities, and baseline year were enrolled from the Taiwan National Health Insurance Research Database (NHIRD). We compared pediatric OSA risk between asthma and non-asthma cohorts by using multivariable Cox regression analysis. Results: We observed a significant relationship between asthma and OSA. In total, we included 305094 children with asthma and 305094 without asthma. The overall incidence rate ratio of OSA was 3.56-fold higher in the asthma cohort than in the non-asthma cohort (566 vs. 249 per 1000 person-year). After adjustment for potential risk factors, the adjusted hazard ratio (HR) of OSA was 1.82 [95% confidence interval (CI)=1.56-2.13]. Regardless of sex, the asthma cohort had a higher OSA risk than the non-asthma cohort did. Patients with asthma, excluding particular comorbidities, had a significantly increased OSA risk. Compared with those without asthma, patients with asthma who had more medical visits for asthma per year (particularly>5 visits per year) had a higher subsequent OSA risk (adjusted HR, 10.1, 95% CI=8.13-12.6). Conclusion: This nationwide retrospective cohort study demonstrated that childhood asthma may increase subsequent pediatric OSA risk.