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Increased Incidence of Obstructive Sleep Apnea in Hospitalized Children After Enterovirus Infection: A Nationwide Population-based Cohort Study

Chen, Vincent Chin-Hung, MD, PhD*,†; Yang, Yao-Hsu, MD, PhD*,‡,§,¶; Kuo, Ting-Yu, MS§; Huang, Kuo-You, PhD; Huang, Yin-Cheng, MD, PhD**; Lee, Yena, PhD††; McIntyre, Roger S., MD, PhD††,‡‡; Huang, Yu-Shu, MD§§; Hsu, Chung-Yao, MD, PhD¶¶,‖‖

The Pediatric Infectious Disease Journal: September 2018 - Volume 37 - Issue 9 - p 872–879
doi: 10.1097/INF.0000000000001892
Original Studies

Background: We report the first nationwide population-based cohort study using Taiwan’s National Health Insurance Research Database on the association between enterovirus (EV) infection and the incidence of sleep disorders in a pediatric population.

Methods: Two matched groups of children under 18 years of age were included in the analyses for nonapneic sleep disorder and obstructive sleep apnea (OSA). Among them, 316 subjects were diagnosed with OSA during the surveillance period, including 182 in the EV infection group and 134 in the non-EV infection group.

Results: Hospitalization because of EV infection was associated with OSA after adjusting for age, sex, urbanization atopic disease and perinatal complications (adjusted hazard ratio: 1.62, 95% confidence interval: 1.18–2.21; P = 0.003). An additional factor significantly associated with sleep apnea was allergic rhinitis (hazard ratio: 4.82, 95% confidence interval: 3.45–6.72).

Conclusions: Children with severe EV infection (ie, requiring hospitalization) carry a significantly higher risk of developing OSA, particularly in those with allergic rhinitis. As pediatric obstructive sleep apnea is a treatable sleep disorder, we emphasize regular follow-up and early detection in children with EV infection.

From the *Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan

Department of Psychiatry / Health Information and Epidemiology Laboratory, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan

Department of Traditional Chinese Medicine

§Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan

Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan

Department of Speech, Language Pathology and Audiology, Chung Shan Medical University and Hospital, Taichung, Taiwan

**Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

††Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada

‡‡Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

§§Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan

¶¶Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

‖‖Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Accepted for publication October 12, 2017.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Chung-Yao Hsu, MD, PhD, Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd, Kaohsiung 804, Taiwan. E-mail:

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