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.

研究目的：儿童阻塞性睡眠呼吸暂停低通气综合征（Pediatric Obstructive Sleep Apnea-Hypopnea Syndrome, OSAHS）常与多种疾病共患，对儿童健康及社会医疗资源造成显著负担。目前国内相关研究尚未系统涵盖儿童OSAHS的共病模式与分布特征，为此本研究针对中国上海市儿童OSAHS的共病特征展开调查。
研究设计：基于大型医院的横断面研究。
研究场景：纳入2013年至2016年中国上海市浦东新区儿科病房的医疗数据。
研究对象：4045名年龄介于0至18岁的中国儿童。
主要与次要结局指标：采用截断值为8分的儿童睡眠问卷（Pediatric Sleep Questionnaire）诊断儿童OSAHS；共病诊断依据中国疾病临床诊疗指南。本研究的结局指标为共病模式及其分布特征，采用卡方检验比较主要共病模式间的差异。
研究结果：主要共病类型为耳鼻咽喉科疾病，包括慢性鼻炎、变应性鼻炎及慢性扁桃体炎。在单共病模式中，OSAHS合并慢性鼻炎（37.53%）与OSAHS合并变应性鼻炎（28.13%）最为常见；在双共病模式中，排名靠前的共病模式包括OSAHS+慢性鼻炎+慢性渗出性中耳炎（10.88%）、OSAHS+变应性鼻炎+慢性渗出性中耳炎（7.94%）、OSAHS+变应性鼻炎+慢性扁桃体炎（4.43%）及OSAHS+慢性鼻炎+慢性扁桃体炎（4.23%）。所有共病组中男性占比均高于女性。单共病组（P=0.035）与双共病组（P<0.001）中排名前五的共病模式均存在显著年龄差异。多数住院患儿年龄介于4至7岁。不同共病模式的手术次数差异同样具有统计学意义（P<0.001；P<0.001）。值得注意的是，双共病组中排名前五的共病模式与住院时长（Length of Stay, LOS）显著相关（P<0.001），而单共病组则未观察到该关联。
研究结论：OSAHS合并鼻炎（慢性鼻炎或变应性鼻炎）是最常见的共病诊断模式。年龄、手术次数及住院时长对共病模式存在显著统计学影响。本研究强调，深入理解儿童OSAHS复杂的耳鼻咽喉科共病诊疗方案，对于改善临床结局、节约医疗资源具有重要意义。