Is Obstructive Sleep Apnea Associated with Behavioral Insomnia of Childhood?

Study objectives: Behavioral Insomnia of Childhood (BIC) and Obstructive Sleep Apnea (OSA) are highly prevalent conditions affecting 10-20% and 1-5% of children respectively, each with specific therapies. Studies in adults have suggested that the co-morbid Insomnia-OSA (COMISA) may have distinct clinical characteristics. The association between the two conditions in the pediatric population has not been previously investigated. The main aim of this study was to examine the association between BIC and OSA in children.

Methods: Children between ages of 0.5 to 10 years referred to a sleep specialist and polysomnography (PSG) at Hadassah Medical Center between the years 2018 to 2021 were included in this retrospective analysis. We excluded children with chromosomal and craniofacial abnormalities, post-tonsillectomy, or neurological impairments. BIC was diagnosed clinically with the help of the BEARS questionnaire. OSA was diagnosed by PSG (AHI>1.2 /hr).

Results: Of 329 children (age 4.39 ± 2.40 [0.5-10] years), 99 were (30.1%) non-OSA non-BIC, 168 (51.1%) OSA non-BIC, 23 (7%) BIC non-OSA, and 39 (11.9%) had COMISA. OSA and non-OSA children had a similar prevalence of BIC. Children in the COMISA group were significantly younger, compared with the remaining groups. Younger age at PSG, premature birth and PLMI, were independently associated with an increased risk of OSA in a multivariable analysis.

Conclusions: Current findings do not support an association between behavioral insomnia and obstructive sleep apnea in children, therefore both should be assessed and treated in children presenting with sleep difficulties.