0833 Identifying Clinical Determinants of Obstructive Sleep Apnea in Children with Sickle Cell Disease

Abstract Introduction Children with sickle cell disease (SCD) are at increased risk for obstructive sleep apnea (OSA). Guidelines recommend screening for OSA in this population based on clinical assessment. Several aspects of OSA in children with SCD remain poorly understood, such as clinical characteristics and the optimal approach for screening. Although polysomnography (PSG) proves valuable for diagnosing individuals who exhibit signs and symptoms of OSA, its cost-effectiveness as a screening tool for asymptomatic children with SCD remains uncertain. There is a need for an effective clinical screening approach for OSA in this population. The objective is to compare the clinical characteristics of children with SCD who had OSA (AHI 1) against those who did not on PSG. Methods All SCD patients aged 2 to 18 between March 2016 to May 2023 attending the Comprehensive Sickle Cell Center who underwent PSG were retrospectively compared with sleep apnea symptoms during clinic visits. Symptoms criteria were retrieved from clinical encounters for snoring, apnea, mouth breathing, gasping, enuresis in children older than ten, morning headache, hyperactivity, daytime sleepiness, and daytime naps. Results From 180 children with SCD who attended the clinic, 56 patients (31.1%) had a PSG performed, whereby 37.5% (n=21) were diagnosed with OSA, and 62.5% (n=35) did not have OSA. In children with OSA, 80.9% (n=17) reported snoring, 23% (n=5) mouth breathing, and 4.7% (n=1) witnessed apnea. From the group without OSA, 40% (n=14) had no symptoms, 42% (n=14) reported snoring, 20% (n=7) mouth breathing, 17.1% (n=6) reported taking naps, 14.2% (n=5) gasping. Despite being the most frequent symptom to occur in those with and without OSA, habitual snoring was significantly higher in the OSA group (p= 0.02). Conversely, in the absence of symptoms, patients were unlikely to have OSA (p=0.003). Conclusion In children with SCD, the absence of symptoms suggests OSA is not present; therefore, PSG may not be warranted. However, the presence of habitual snoring may be an indicator for OSA requiring PSG confirmation. Support (if any)