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Volume 15 No. 10
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Accepted Papers

Scientific Investigations

Obstructive Sleep Apnea in Children With Autism

Anna Tomkies, BA1; Romaine F. Johnson, MD, MPH1; Gopi Shah, MD, MPH1; Michelle Caraballo, MD2; Patricia Evans, MD, PhD3; Ron B. Mitchell, MD1
1Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas; 2Division of Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas; 3Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas

Study Objectives:

To describe the demographic and clinical characteristics of children with autism spectrum disorder (ASD) referred for polysomnography (PSG) and to look for predictors of obstructive sleep apnea (OSA) and severe OSA in these children.


This is a retrospective case series of children ages 2 to 18 years who underwent PSG between January 2009 and February 2015. Children were excluded if they had major comorbidities, prior tonsillectomy, or missing data. The following information was collected: age, sex, race, height, weight, tonsil size, and prior diagnosis of allergies, asthma, gastroesophageal reflux disease, seizure disorder, developmental delay, cerebral palsy, or attention deficit hyperactivity disorder. Predictors of OSA were evaluated.


A total of 45 children were included with a mean (standard deviation [SD]) age of 6.1 years (2.8). The patients were 80% male, 49% Hispanic, 27% African American, 22% Caucasian, and 2.2% other. Of these children 26 (58%) had OSA (apnea-hypopnea index [AHI] > 1 event/h) and 15 (33%) were obese (body mass index, body mass index z-score ≥ 95th percentile). The mean (SD) AHI was 7.7 (15.0) events/h (range 1.0–76.6). A total of 9 (20%) had severe OSA (AHI ≥  10 events/h). There were no demographic or clinical predictors of OSA in this group. However, increasing weight served as a predictor of severe OSA and African American or Hispanic children were more likely obese.


The absence of demographic or clinical predictors of OSA supports using general indications for PSG in children with ASD.


Tomkies A, Johnson RF, Shah G, Caraballo M, Evans P, Mitchell RB. Obstructive sleep apnea in children with autism. J Clin Sleep Med. 2019;15(10):1469–1476.

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