Original Article
Obstructive Sleep Apnea Syndrome Increases Pedestrian Injury Risk in Children

https://doi.org/10.1016/j.jpeds.2014.09.032Get rights and content

Objectives

To evaluate pedestrian behavior, including reaction time, impulsivity, risk-taking, attention, and decision-making, in children with obstructive sleep apnea syndrome (OSAS) compared with healthy controls.

Study design

Using a case control design, 8- to 16-year-olds (n = 60) with newly diagnosed and untreated OSAS engaged in a virtual reality pedestrian environment. Sixty-one healthy children matched using a yoke-control procedure by age, race, sex, and household income served as controls.

Results

Children with OSAS were riskier pedestrians than healthy children of the same age, race, and sex. Children with OSAS waited less time to cross (P < .01). The groups did not differ in looking at oncoming traffic or taking longer to decide to cross.

Conclusions

Results suggest OSAS may have significant consequences on children's daytime functioning in a critical domain of personal safety, pedestrian skills. Children with OSAS appeared to have greater impulsivity when crossing streets. Results highlight the need for heightened awareness of the consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention.

Section snippets

Methods

One hundred twenty-one children participated; 61 of the children were diagnosed with OSAS. Diagnosis and recruitment of that portion of the sample occurred at the Pediatric Sleep Disorders Center at Children's of Alabama. All participating children met International Classification of Sleep Disorders Second Edition diagnostic criteria for OSAS23 based on diagnostic assessments that included nocturnal polysomnography (NPSG) using Sandman 9.2 technology software (Embla, Broomfield, Colorado) and

Results

As expected based on recruitment of matched samples using a yoke-control procedure, there were no significant differences between groups in terms of age, race, sex, and household income (all Ps > .10; see Table I). Also as expected, children with OSAS were sleepier than healthy controls (Wilcoxon signed rank test, W(56) = 4.24, P < .0001). The age- and sex-adjusted body mass index (BMI) of OSAS group (mean = 32.94, SD = 7.58) was significantly higher than that of control group (mean = 24.35,

Discussion

Children with OSAS were more likely to get hit or nearly hit by a virtual vehicle than a control group of children matched using a yoke-control procedure by age, sex, race, and household income. This finding extends previous reports documenting the harmful effect of sleep deprivation on transportation safety of adults and adolescents.13, 14, 15 In particular, this study offers initial evidence that untreated OSAS may be associated with increased injury risk to children in pedestrian settings.

We

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    Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (R01HD058573) and the Faculty Development Office at the University of Alabama at Birmingham. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health. The authors declare no conflicts of interest.

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