Sleep apnea disparities in kids: Obesity may override impact of race, socioeconomics

Black children have a fourfold higher risk of severe sleep apnea than peers and are also more likely to experience persistent symptoms following the most effective surgery option.

As researchers explored potential reasons behind racial disparities in treatment outcomes for children with severe sleep apnea, they were expecting to find the answer in socioeconomic factors.

But they were surprised to learn that when one risk factor – obesity – was taken out of the equation, race was no longer associated with worse post-surgery outcomes for obstructive sleep apnea.

“Obesity seems to be sort of the great equalizer when it comes to risks of persistent sleep apnea following surgery treatment,” said senior author Erin Kirkham, M.D., M.P.H., a pediatric otolaryngologist at University of Michigan Health C.S. Mott Children’s Hospital.

“Among obese children, there was no association between race and outcome. However, nonobese Black children were nearly five times as likely to have residual sleep apnea as nonobese non-Black children.”

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The Michigan Medicine research team analyzed data from 224 children ages 5-9 across seven health centers with mild-to-moderate obstructive sleep apnea who underwent adenotonsillectomy – which involves removing both tonsils and adenoids – and experienced residual obstructive sleep apnea six months after surgery.

Data came from the Childhood Adenotonsillectomy Trial from 2007 to 2012. The trial compared neuropsychological and health outcomes for children with mild-to-moderate obstructive sleep apnea who received early adenotonsillectomy versus watchful waiting with supportive care.

Black children, who made up a little over half the study population, had 2.7 times greater odds of residual sleep apnea compared with children of other racial groups, Michigan Medicine researchers found.

But after accounting for obesity, the risks for continued sleep apnea after surgery were the same regardless of race, suggests the new findings published in Otolaryngology-Head and Neck Surgery.

 The racial disparity in baseline risk and severity in sleep apnea for Black children has been associated with socioeconomic factors but the disparity in treatment response remains unexplained.” Erin Kirkham, M.D., M.P.H.

This countered the research team’s hypothesis that other child-level variables, such as asthma and second-hand smoke exposure, or socioeconomic factors, such as parental health and neighborhood disadvantage, were significant determinants of outcome.

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“Our findings suggest that obesity is a substantial driver of post-surgery outcomes and overrides the impact of race and other socioeconomic factors,” said lead author Shannon Fayson, M.D., who was an otolaryngology resident at Michigan Medicine at the time of the study and is currently a pediatric fellow at Cincinnati Children's Hospital Medical Center.

“Our central theory was that the disparity in treatment outcome among Black children with severe sleep apnea could at least be partly explained by child and socioeconomic factors. However, none of the socioeconomic variables that we examined in our study had significant influence.”

Obstructive sleep apnea, which causes breathing interruptions during sleep, has been associated with cognitive deficits, behavioral problems, mood impairments, excessive daytime sleepiness, impaired school performance, developmental delay and cardiovascular complications like heart failure.

“The racial disparity in baseline risk and severity in sleep apnea for Black children has been associated with socioeconomic factors but the disparity in treatment response remains unexplained,” Kirkham said.

“This has significant public health implications and we need more research to better tailor interventions for populations at risk for persistent post-adenotonsillectomy sleep apnea.”

Additional authors include Aleda Leis Ph.D., Susan Garetz, M.D., M.S. and Gary L. Freed, M.D., M.P.H., all of U-M.

Study cited: “Racial Disparity in Residual Sleep Apnea After Adenotonsillectomy,” doi.org/10.1002/ohn.366