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Randomized Controlled Trial
. 2023 Nov;169(5):1309-1318.
doi: 10.1002/ohn.366. Epub 2023 May 20.

Racial Disparity in Residual Sleep Apnea After Adenotonsillectomy

Shannon D Fayson  1 , Aleda M Leis  2 , Susan L Garetz  1 , Gary L Freed  3 , Erin M Kirkham  1
Affiliations
Randomized Controlled Trial

Racial Disparity in Residual Sleep Apnea After Adenotonsillectomy

Shannon D Fayson et al. Otolaryngol Head Neck Surg. 2023 Nov.

Abstract

Objective: Black children have a higher risk of residual obstructive sleep apnea after adenotonsillectomy than non-Black children. We analyzed Childhood Adenotonsillectomy Trial data to better understand this disparity. We hypothesized that (1) child-level factors, such as asthma, smoke exposure, obesity, sleep duration, and (2) socioeconomic factors, such as maternal education, maternal health, and neighborhood disadvantage, may confound, modify, or mediate the association between Black race and residual obstructive sleep apnea after adenotonsillectomy.

Study design: Secondary analysis of a randomized controlled trial.

Setting: Seven tertiary care centers.

Methods: We included two hundred and twenty-four 5-to-9-year-olds with mild-to-moderate obstructive sleep apnea who underwent adenotonsillectomy. The outcome was residual obstructive sleep apnea 6 months after surgery. Data were analyzed with logistic regression and mediation analysis.

Results: Of 224 included children, 54% were Black. Compared with non-Black children, Black children had 2.7 times greater odds of residual sleep apnea (95% confidence interval [CI]: 1.2, 6.1; p = .01), adjusted for age, sex, and baseline Apnea Hypopnea Index. There was significant effect modification by obesity. Among obese children, there was no association between Black race and outcome. However, nonobese Black children were 4.9 times as likely to have residual sleep apnea than non-Black children (95% CI: 1.2, 20.0; p < 0.01). There was no significant mediation by any of the child-level or socioeconomic factors tested.

Conclusion: There was substantial effect modification by obesity on the association between Black race and residual sleep apnea after adenotonsillectomy for mild-to-moderate sleep apnea. Black race was associated with poorer outcome among nonobese but not obese children.

Keywords: health disparities; health equity; pediatric OSA; public policy; racism; social determinants of health.

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References

REFERENCES

    1. Wang R, Dong Y, Weng J, et al. Associations among neighborhood, race, and sleep apnea severity in children. A six-city analysis. Ann Am Thorac Soc. 2017;14(1):76-84. doi:10.1513/AnnalsATS.201609-662OC2
    1. Rosen CL, Larkin EK, Kirchner HL, et al. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr. 2003;142(4):383-389. doi:10.1067/mpd.2003.28
    1. Weinstock TG, Rosen CL, Marcus CL, et al. Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates. Sleep. 2014;37(2):261-269. doi:10.5665/sleep.3394
    1. Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368(25):2366-2376. doi:10.1056/NEJMoa1215881
    1. Zhang GQ, Cui L, Mueller R, et al. The National Sleep Research Resource: towards a sleep data commons. J Am Med Inform Assoc. 2018;25(10):1351-1358. doi:10.1093/jamia/ocy064

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