Pediatric sleep apnea and craniofacial anomalies: A population-based case-control study

Derek J. Lam, Christine C. Jensen, Beth A. Mueller, Jacqueline R. Starr, Michael L. Cunningham, Edward M. Weaver

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Objective: To investigate the association between craniofacial anomalies and diagnosis with obstructive sleep apnea (OSA) in a large, populationbased sample of children. Design: Retrospective case-control study. Methods: Cases of OSA (n = 1,203) were identified by International Classification of Diseases-9 codes consistent with OSA in the 1987-2003 Washington State inpatient discharge database among children ≤18 years of age and born in Washington state. For each case, five controls without OSA (n = 6,015) were randomly selected from the remaining Washington State births, frequency matched by birth year. Congenital anomaly diagnoses and covariates were extracted from discharge data for all inpatient hospitalizations during the study period and linked birth certificate data. Multiple logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between congenital anomalies (including subgroups) and OSA. Results: An OSA diagnosis was strongly associated with the presence of any craniofacial anomaly (adjusted OR 38, 95%CI [24, 60]) and, in particular, with orofacial cleft (adjusted OR 40, 95%CI [17, 94]) and Down syndrome (adjusted OR 51, 95%CI [20, 128]). OSA was less associated with any noncraniofacial malformation (adjusted OR 4.1, 95%CI [3.1, 5.3]), which may reflect the relatively small effect of inpatient exposure bias in the associations above. Conclusions: The presence of congenital craniofacial anomalies is strongly associated with inpatient diagnosis of OSA. These findings persist even after control of major potential biases. Parents and clinicians should consider screening for OSA among children with craniofacial anomalies.

Original languageEnglish (US)
Pages (from-to)2098-2105
Number of pages8
Issue number10
StatePublished - Oct 2010
Externally publishedYes


  • Craniofacial
  • Down syndrome
  • Orofacial cleft
  • Pediatric sleep apnea

ASJC Scopus subject areas

  • Otorhinolaryngology


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