Characteristics of comorbidity patterns in children with obstructive sleep apnoea-hypopnoea syndrome in Shanghai, China: A cross-sectional study

Objectives: Paediatric obstructive sleep apnoea-hypopnoea syndrome (OSAHS), which usually cooccurs with various diseases, significantly impacts health and social resources. However, domestic paediatric OSAHS studies have not included comorbidity patterns or distribution characteristics. Thus, we investigated the comorbidity characteristics of paediatric OSAHS in Shanghai, China.Design: A large hospital-based cross-sectional study.Setting: Paediatric ward medical data from the Pudong New Area, Shanghai, China from 2013 to 2016.Participants: 4045 Chinese children aged 0-18 years.Primary and secondary outcome measures: Paediatric OSAHS was diagnosed using the Paediatric Sleep Questionnaire with a cut-off score of 8 points. Comorbidities were diagnosed based on Chinese guidelines for specific diseases. The outcomes were comorbidity patterns and their characteristics. Chi-square tests were performed to compare differences among top comorbidity patterns.Results: Major comorbidities were otolaryngological morbidities, including chronic rhinitis, allergic rhinitis, and chronic tonsillitis. Among 1-comorbidity patterns, OSAHS+chronic rhinitis (37.53%) and OSAHS+allergic rhinitis (28.13%) were most common. Among 2-comorbidity patterns, OSAHS+chronic rhinitis+chronic exudative otitis media (10.88%), OSAHS+allergic rhinitis+chronic exudative otitis media (7.94%), OSAHS+allergic rhinitis+chronic tonsillitis (4.43%) and OSAHS+chronic rhinitis+chronic tonsillitis (4.23%) were most common. Males predominated in all comorbidity groups. Age differences for top five patterns in both the 1-comorbidity group (P=0.035) and 2-comorbidities group (P<0.001) were statistically significant. Most inpatients were between 4 and 7 years old. Similarly, differences in the number of operations among various patterns were obtained (P<0.001; P<0.001). Notably, top five patterns of the 2-comorbidities group were significantly associated with the length of stay (LOS) (P<0.001), while those in the 1-comorbidity group were not.Conclusion: OSAHS+rhinitis (chronic rhinitis or allergic rhinitis) was the most common diagnosis. Age, number of operations, and LOS statistically significantly affected the patterns. This emphasizes the importance of better understanding complex otolaryngological comorbidity diagnoses and treatments in paediatric OSAHS to reverse clinical outcomes and save health resources.