Vitamin D Supplementation Could Aid Pediatric Obstructive Sleep Apnea

New study findings showed that vitamin D deficiency was common among children undergoing adenotonsillectomy for severe obstructive sleep apnea (OSA), emphasizing the need for further research on vitamin D supplementation to aid pediatric OSA.¹

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OSA is a sleep-related disorder breathing disorder that occurs when a blockage in the airway keeps an individual’s air from moving through the body while asleep. The blockage causes a lack of airflow that makes blood oxygen levels drop and leads to a survival reflex in the brain that wakes the body slightly to breathe again.^1,2 Data has shown that the disorder occurs in around 1% to 6% of children in the US, often caused by large tonsils or adenoids in the upper airway.³ However, the exact pathophysiologic mechanism of OSA in children remains to be a focus in research—with adenotonsillar hypertrophy as the most common cause.¹

Symptoms of OSA in pediatrics include loud snoring, noisy breathing, pauses in breathing that last a few seconds to a minute, mouth breathing, restlessness during sleep, sleepiness or irritability, bedwetting, morning headaches, and behavioral problems.⁴ Following, study authors noted that OSA relates to metabolic changes, growth inhibition, and cardiovascular sequelae that can significantly impact quality of life and cognitive function in children.¹

According to the release, the American Academy of Pediatrics suggests that primary care physicians screen for OSA in routine check-ups. However, it is often difficult to decipher primary snoring and OSA. A full night in laboratory polysomnogram (PSG) is the current standard measure of diagnosis and the severity of pediatric OSA is categorized based on the obstructive Apnea-Hypopnea Index (AHI) on PSG.¹

Previous studies conducted on adults with OSA suggested that vitamin D deficiency related to the disorder, allowing researchers to assess the link between low vitamin D levels with pediatric OSA in a cross-sectional study. Vitamin D deficiency was classified by 25-hydroxyvitamin (25[OH]D) less than 20 mg/mL, which occurs in 10% of children aged 1 to 11 years of age, according to study authors.¹

The study included 72 children, with the mean age of 6.7 years with severe OSA that were undergoing adenotonsillectomy at a tertiary care pediatric otolaryngology clinic. Using polysomnography metrics, serum 25[OH]D levels were assessed, and fasting blood samples were gathered to identify vitamin D deficiency among the children.¹

“A multivariable linear regression model for baseline obstructive AHI was used to determine the association with serum 25(OH)D levels after accounting for possible modifying variables including age, sex, race, BMI percentile for age, season, and history of asthma,” the study authors said in a news release.¹

The results displayed that the mean AHI was 42.8 and vitamin D deficiency was reported in 27 individuals included in the study. Additionally, the study authors noted that in the univariate analysis, vitamin D deficiency was connected to children younger in age, individuals that are Black, female individuals, and those with higher obstructive AHI. In the multivariable analysis, low vitamin D levels remained connected with AHI. Further results displayed that among the 72 children, 37.5% had a vitamin D deficiency, suggesting that low levels impacted higher obstructive AHI scores.¹

The findings suggest that further research needs to be conducted to identify if vitamin D supplementation could positively impact OSA in children, according to study authors.¹

REFERENCES

1. Bluher AE, Kearney T, Vazifedan T, Baldassari CM. Vitamin D Deficiency and Pediatric Obstructive Sleep Apnea Severity. JAMA Otolaryngol Head Neck Surg. Published online October 31, 2024. doi:10.1001/jamaoto.2024.3737

2. Cleveland Clinic. Obstructive Sleep Apnea. November 15, 2022. Accessed November 1, 2024. https://my.clevelandclinic.org/health/diseases/24443-obstructive-sleep-apnea-osa

3. Mayo Clinic. Pediatric obstructive sleep apnea. July 29, 2023. Accessed November 1, 2024. https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196#

4. Cedars Sinai. Obstructive Sleep Apnea in Children. News release. Accessed November 1, 2024. https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/o/obstructive-sleep-apnea-in-children.html