Children with less severe autism spectrum disorder (ASD) are more likely to have more obstructive sleep apnea (OSA) symptoms and be diagnosed with it later in life compared with children without ASD, according to a study published in International Journal of Pediatric Otorhinolaryngology.
Children with ASD frequently have OSA, and they may have a range of symptoms. Those symptoms can overlap with those associated with ASD, leading to a missed diagnosis of OSA. The gold standard for diagnosing OSA, overnight polysomnography (PSG), is a procedure that can be challenging for children with ASD. Yet, early diagnosis of OSA is crucial. Few studies have analyzed differences in diagnosis of OSA among children with and without ASD.
In the current study, researchers conducted those comparisons and assessed how ASD severity influences OSA symptoms and age at OSA diagnosis.
They reviewed data of 166 pediatric patients with PSG-confirmed OSA undergoing adenotonsillectomy (AT) at an academic medical center between 2019 and 2021. Seventy-five patients (88% boys) with ASD participated in the experimental group, and 91 patients (54.9% boys) without ASD were classified as control individuals.
The researchers assessed ASD severity on a 1 to 4 Likert scale based on social-communication and behavioral symptoms, with 4 being most severe.
Age at OSA diagnosis was not significantly different among patients with ASD and control individuals (72.8 months vs 73.4 months).
In multivariate analyses, the researchers found that patients with ASD tended to have more OSA symptoms compared with patients without ASD (P <.0001) and body mass index (BMI) and age at ASD diagnosis were associated with age at OSA diagnosis (P = .0033, P<.001, respectively).
Lower autism severity was associated with a higher quantity of reported OSA symptoms (P=.006) and increased age at diagnosis (P=.002). Mean total apnea hypopnea index and obstructive apnea-hypopnea index were in the severe OSA range in the control group but in the moderate OSA range in the ASD group. Total apnea-hypopnea index was associated with autism severity (P =.022).
“The current study reveals that children with less severe ASD are more likely to report an increased number of OSA symptoms and be diagnosed at a later age than children without ASD,” the researchers said. “Clinicians should have a heightened sense for OSA evaluation in children with ASD, particularly in children with lower severity of ASD and increased BMI.”
The researchers said patients with less severe ASD symptomology might report more OSA symptoms because they can more easily communicate symptoms parents don’t notice. Doctors and parents might be more likely to attribute symptoms of patients with more severe ASD to ASD instead of OSA. They also said children with more severe ASD are likely to be in the health care system, more frequently evaluated by doctors, with a lower threshold for undergoing diagnostic testing to evaluate OSA symptoms.
Limitations of the study included its retrospective nature, lack of match by age or sex, sample size, and generalizability to general population at nonacademic institutions, patients in other regions, adult patients, and children with OSA who received a different treatment besides adenotonsillectomy.
Santapuram P, Chen H, Weitlauf AS, et al. Investigating differences in symptomatology and age at diagnosis of obstructive sleep apnea in children with and without autism. Int J Pediatr Otorhinolaryngol. Published online May 27, 2022. doi: 10.1016/j.ijporl.2022.111191