Role of Arousal Threshold in Sleep Health Disparities and Outcomes Among Pediatric Patients with Obstructive Sleep Apnea

Black/African American (Black) children are at increased risk of experiencing continued obstructive sleep apnea (OSA) disease following adenotonsillectomy (A&T), which is the first-line treatment for OSA in children. The nadir epiglottic pressure preceding arousal, known as the arousal threshold (ArTH), and allostatic load (AL), a measure of the impact of environmental stress on the body, are both associated with the severity and incidence of the disease. However, the contribution of these factors to the sleep health disparities among Black pediatric patients is unknown. Therefore, our overall objective of this study was to determine the role of arousal threshold and allostatic load in sleep health disparities amongst treatment outcomes in pediatric patients with OSA. The current study leveraged archival data from the Childhood Adenotonsillectomy Trial (CHAT). 464 children aged 5 to 9 years with obstructive sleep apnea were randomized to receive either early adenotonsillectomy or watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were examined at baseline and after seven months. Our sample included 183 participants who had the required allostatic load baseline data for the analysis and a sub-sample of 98 participants who underwent adenotonsillectomy surgery and had follow-up data. We examined AL index among Black and White children to identify differences and create a model that could explain the noted sleep disparities in response to adenotonsillectomy surgery. To achieve the overall objective and test the first hypothesis that Black children will have increased arousal threshold and allostatic load compared to their White counterparts, univariate ANCOVAs were conducted to determine potential differences between Black and White children for ArTH and AL adjusted for demographic and socioeconomic factors. To test the second hypothesis that increased arousal threshold and allostatic load will predict higher adenotonsillectomy failure rates. Quadratic discriminant function analysis was used to determine if ArTH and AL load predicts adenotonsillectomy failure. A&T failure is defined as a participant having an obstructive apnea index (OAI) ≥ 1 and an apnea-hypopnea index (AHI) ≥ 2 at follow-up 7 months after A&T. Key findings were an increased allostatic load in Black children (P=0.09) and an interaction effect between race and premature birth. Black Children born premature had a higher allostatic load than White children born premature (P=0.09). Additionally, among the subsample of participants who underwent adenotonsillectomy surgery, a difference between Black and White race was found for ArTH (p < 0.05). For predicting the success and failure of adenotonsillectomy surgery, the test model showed a 54.8% success rate in predicting group membership. The findings from our study can be used to guide the development and testing of future sleep health interventions and further elucidate the etiology of sleep health disparities