Longitudinal associations of obstructive sleep apnea with clinical disorders relevant to school functioning in school-aged children: A multicenter cohort study.

Background

Pediatric obstructive sleep apnea (OSA) has been associated with difficulties in school functioning, but evidence has largely relied on neurocognitive, behavioral, academic, and educational assessments. We examined whether these concerns are also reflected in clinically recognized disorders across learning, communication, and emotional domains during longitudinal care.

Methods

This retrospective multicenter cohort study included children aged 6-12 years with polysomnography-supported OSA without adenotonsillectomy (AT) and propensity score-matched healthy controls. Risks of learning disorders, speech and language disorders, childhood-onset emotional disorders, and anxiety disorders were evaluated over 1, 2, 3, and 5 years. Secondary comparisons examined 5-year patterns involving children who subsequently underwent AT.

Results

The primary analysis included 7136 matched pairs. OSA without AT was associated with higher risks of all four outcomes across all follow-up periods. At 5 years, hazard ratios were 1.86 (95% CI, 1.56-2.23) for learning disorders, 2.25 (1.82-2.77) for speech and language disorders, 1.45 (1.04-2.04) for childhood-onset emotional disorders, and 1.41 (1.26-1.56) for anxiety disorders. Secondary comparisons showed more favorable 5-year patterns among children who subsequently underwent AT. Primary findings remained consistent after excluding documented snoring from healthy controls.

Conclusions

PSG-supported OSA without AT was longitudinally associated with subsequently documented disorders across multiple domains relevant to school functioning. These findings suggest that school-functioning concerns associated with pediatric OSA may also be reflected in clinically recognized disorders during longitudinal care.