Sleep-disordered breathing in a multi-ethnic cohort of preterm adolescents and adults: assessment of neonatal and subsequent risk factors.

Study objectives: Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry.

Methods: This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI.

Results: Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001).

Conclusions: Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.