Peer-reviewed article
Nighttime Respiratory Disturbance and Hypoxemia Associated with Impaired Linear Growth in Children with Obstructive Sleep Apnea
Yuan Shi, Zhaohua Chen, Xujun Feng, Fei Lei, Lu Tan et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This retrospective study looked at 2443 children assessed for suspected obstructive sleep apnea (OSA), a condition where breathing is repeatedly disrupted during sleep. All children had an overnight sleep study and their height measured. Children who spent more of the night with low blood oxygen (below 90%) had lower height scores. The number of breathing interruptions per hour was not linked to height in the same way when height was treated as a continuous score. Children with moderate or severe OSA, and those in the highest low-oxygen group, had higher odds of being short for their age than children without OSA. The authors suggest that height should be checked routinely when managing children with OSA.
Key points
- 2443 children were included: 348 without OSA and 2095 with OSA.
- Higher time with oxygen saturation below 90% (T90%) was linked to a lower height z-score (B = -0.005, 95% CI -0.010 to -0.000, P = 0.033).
- The apnea-hypopnea index (AHI) was not linked to the continuous height z-score (full sample P = 0.111).
- Compared with children without OSA, odds of subclinical growth impairment were higher with moderate OSA (OR 1.73) and severe OSA (OR 1.96).
- Children in the highest T90% quartile had higher odds of growth impairment (OR 2.17, 95% CI 1.30-3.60).
Limitations
This is a retrospective cross-sectional study, so it shows associations and cannot show that OSA or low oxygen causes poorer growth. Nutrition, endocrine disorders, chronic illnesses and parental height were not collected or adjusted for. The text does not name the study setting or country, so the geography is unclear.
Abstract
Objectives: Although obstructive sleep apnea (OSA) related hypoxia shows stronger associations with multiple complications than respiratory disturbance, its impact on linear growth, a major pediatric concern, remains unclear. This study investigates independent effects of hypoxia and respiratory disturbance on the height of children with OSA. Methods: This retrospective, cross-sectional study clinically evaluated children with suspicious OSA from January 2013 to June 2025. Individuals with other sleep disorders, severe neuropsychiatric disorders and physical disorders were excluded. Subjects underwent overnight polysomnography (PSG) and height measurement. OSA was defined as apnea-hypopnea index (AHI) ≥ 1 event/hour, and those with AHI < 1 event/hour served as the non-OSA reference group. AHI and percentage of total sleep time with oxygen saturation < 90% (T90%), were separately used to evaluate the severity of respiratory disturbance (mild, 1≤AHI < 5 events/h; moderate, 5≤AHI < 10 events/h; severe, AHI ≥ 10 events/h) and hypoxia (T90% quartiles). Height z-scores ≤-1 SD defined subclinical growth impairment. Linear and logistic regression models analyzed the independent associations between AHI and T90% and height and subclinical growth impairment. Nutrition, endocrine disorders, chronic illnesses, and parental height were not collected and adjusted in this study. Results: A total of 2443 children were included (348 children without OSA, 2095 children with OSA). In linear regression models, higher T90% was associated with a lower height z-score in the full sample ( B = − 0.005, 95% CI: − 0.010 to − 0.000, P = 0.033) and children with OSA ( B = − 0.005, 95% CI: − 0.010 to − 0.000, P = 0.034), whereas AHI was not (full sample: B = − 0.003, 95% CI: − 0.006 to 0.001, P = 0.111; children with OSA: B = − 0.002, 95% CI: − 0.005 to 0.002, P = 0.330).Logistic models showed higher odds of subclinical growth impairment in children with moderate (OR = 1.73, 95% CI: 1.05– 2.84) or severe OSA (OR = 1.96, 95% CI: 1.19– 3.21) and in those in the highest T90% quartile (OR = 2.17, 95% CI: 1.30– 3.60), compared with children without OSA. These associations remained stable in females and children aged 2– 9 years. Conclusions: To our knowledge, this is the first study to show that greater respiratory disturbance and nocturnal hypoxemia are associated with a higher risk of short stature in children with OSA. These findings support routine height assessment in the clinical management of pediatric OSA. Keywords: obstructive sleep apnea, children growth, height, polysomnography, apnea-hypopnea index, hypoxia