(A1215) Obstructive Sleep Apnea in Pediatric Patients with Fontan Circulation: A Database Driven Analysis

Introduction: Obstructive sleep apnea (OSA) negatively impacts pediatric patients, particularly those with Fontan circulation, a congenital heart condition with extensive comorbidities. OSA can worsen complications but is poorly studied in this population. This study investigates incidence of OSA in Fontan patients and compares their complications and management to non-Fontan peers.

Methods: A retrospective analysis was performed using TriNetX, a de-identified global health network data platform. Pediatric patients who underwent Norwood, Glenn, or Fontan procedures were identified. OSA was diagnosed in these patients, excluding those with congenital risk factors for OSA. Fontan patients were age-matched to non-Fontan patients. BMI, diagnostic methods, treatment, and complications like pulmonary hypertension (PH), ADHD, anxiety, and depression were compared.

Results: Of the 4303 patients with Fontan circulation, 309 (7.18%) were diagnosed with OSA. This cohort was compared to 260,519 non-Fontan pediatric patients with OSA. Of the BMI stratifications, a greater proportion of Fontan patients were classified as underweight and healthy weight compared to the non-Fontan cohort (p < 0.001). Fontan patients were more likely to undergo polysomnography (PSG) for OSA (p < 0.0001), but use of PSG with titration did not differ (p=0.427). Surgical interventions (adenoidectomy and tonsillectomy) were less common in Fontan patients (p < 0.0001), who used CPAP more often (p < 0.0001). Fontan patients had higher rates of PH (p < 0.0001) and anxiety (p < 0.0001), but similar rates of ADHD (p=0.314) or depression (p=0.135).

Conclusions: This study is one of the largest to explore OSA outcomes in Fontan patients, highlighting key differences in diagnosis, treatment, and complications compared to the general population. Despite a lower prevalence of obesity, Fontan patients experience a similar or greater burden of OSA-related complications. The increased use of PSG and CPAP offers valuable insights for tailored management strategies, helping providers implement targeted screening and interventions for Fontan patients.