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Volume 14 No. 09
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Accepted Papers

Scientific Investigations

Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart Disease

Daniel Combs, MD1,2,3; Grant Skrepnek, PhD, RPh4; Michael D. Seckeler, MD, MSc5; Brent J. Barber, MD5; Wayne J. Morgan, MD1; Sairam Parthasarathy, MD2,3
1Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, Arizona; ; 2Department of Medicine, University of Arizona, Tucson, Arizona; 3University of Arizona Health Sciences Center for Sleep and Circadian Sciences and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona; 4Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma, Oklahoma City, Oklahoma; 5Department of Pediatrics, Division of Cardiology, University of Arizona, Tucson, Arizona

Study Objectives:

Sleep-disordered breathing (SDB) has adverse cardiovascular effects in children and adults. In adults with cardiac disease, SDB is highly prevalent and confers increased mortality risk. It is unknown if SDB confers a similar risk in infants with congenital heart disease (CHD). We evaluated clinical and economic outcomes associated with SDB among inpatient infants with CHD in the United States from 1997–2012.


This retrospective, cross-sectional study used discharge data from the Kids' Inpatient Database. Inclusion criteria included diagnosed CHD and age younger than 1 year. Exclusion criteria included apnea of prematurity, cardiac surgery during admission, and invasive mechanical ventilation. Generalized linear models were used to assess outcomes of mortality, length of stay, and total charges after controlling for SDB, clinical characteristics, hospital characteristics, and economic factors.


Across 461,778 inpatient infant cases of CHD from 1997–2012, 4,839 involved SDB (14% obstructive, 4% central, 82% not specified). Multivariable analyses show that central sleep apnea was independently associated with increased risk of inpatient mortality (odds ratio 4.3), 92% longer inpatient stay, and 112% higher total charges when compared to infants with CHD without comorbid SDB (P < .05). Obstructive and unspecified SDB were associated with longer adjusted lengths of stay (56% and 18%, respectively) and higher charges (48% and 21%, respectively) relative to infants with CHD without comorbid SDB (P < .001).


SDB, particularly central sleep apnea, was independently associated with worse outcomes in hospitalized infants with CHD. Further research on whether treatment of SDB in infants with CHD can abrogate adverse patient outcomes is needed.


Combs D, Skrepnek G, Seckeler MD, Barber BJ, Morgan WJ, Parthasarathy S. Sleep-disordered breathing is associated with increased mortality in hospitalized infants with congenital heart disease. J Clin Sleep Med. 2018;14(9):1551–1558.

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