OSA and Cerebral Palsy: A Call to Increase Awareness

Introduction: Children with cerebral palsy (CP) have higher prevalence of obstructive sleep apnea (OSA) and more severe OSA than those without CP. However, currently there are no recommendations for routine OSA screening for children with CP, and sleep evaluation varies amongst providers. This study investigated the prevalence, diagnosis, and treatment of OSA in children with CP.

Methods: A retrospective review of electronic medical records between 2012-2022 from a single tertiary academic center was done to investigate the prevalence and treatment of OSA in children with CP aged 21 years or younger.

Results: Overall, 1,995 children with a diagnosis of CP were identified, and of these, 400 (20%) were diagnosed with OSA. Only 583 of the 1,995 children (29%) had an order for sleep evaluation, and a sleep study was available from 440 children. The median age of initial sleep evaluation was 7 years (range 0-21 years). Polysomnographic variables demonstrated a median Total Sleep Time (TST) of 418 minutes (range 29-553), median Apnea-Hypopnea Index (AHI) of 3.4 (range 0-118), and median minimum oxygen saturation of 87% (range 45-96). Most children (81%) had an AHI>1.0. Of these, 51% had mild, 21% had moderate, and 28% had severe OSA. In children with OSA, 31% had a CPAP order, 44% underwent tonsillectomy and/or adenoidectomy, and 8% had a tracheostomy.

Conclusions: OSA is likely underdiagnosed and undertreated in children with CP, increasing their risk for adverse cardiovascular and neurocognitive effects. Over a ten-year period at a tertiary academic center, only 29% of children with CP received an order for sleep evaluation. There was a wide range in the age of initial sleep evaluation. Increased awareness of the importance of early sleep evaluation in patients with CP could reduce the risks of undertreated OSA.