Obstructive sleep apnea and fractures in children and adolescents

Study Objectives:
To examine, among girls and boys, associations between site-specific extremity fracture and sleep apnea diagnosis or treatment.
Methods:
A cross-sectional analysis of claims data from 2016-2018 for children aged 2-18. Children with sleep apnea, continuous positive airway pressure, adenotonsillectomy, and fracture were identified using ICD10, CPT and HCPCS codes. We examined sex-stratified associations between site-specific fracture, sleep apnea and sleep apnea treatment.
Results:
Among 2,327,104 children, 9,547 (0.41%) had sleep apnea and nearly 61% were treated. Girls with sleep apnea, treated or untreated, had increased odds of lower, but not upper, extremity fracture compared to those without sleep apnea (treated 1.56, 95% CI 1.11, 2.21; untreated OR 1.63, 95% CI 1.09, 2.44). Only boys untreated for sleep apnea had increased odds of lower extremity fracture in comparison to those without a diagnosis of sleep apnea (OR 1.65, 95% CI 1.20,2.27). Interestingly, boys treated for sleep apnea but not those untreated, in comparison to boys without sleep apnea, had different (reduced) odds of upper extremity fracture (OR 0.74, 95% CI 0.59, 0.95).
Conclusions:
These large datasets provide evidence that both boys and girls with untreated sleep apnea have higher odds of lower extremity fractures. However, treatment for sleep apnea was associated with improved odds of lower extremity fracture only in boys. Upper extremity data were less clear. These data are cross-sectional and cannot show causality, but they suggest that treatment for sleep apnea may lower risk for extremity fractures in boys