{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:32:35Z","timestamp":1783776755067,"version":"3.55.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T00:00:00Z","timestamp":1600041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Division of Pulmonary and Sleep Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Study Objectives<\/jats:title>\n                  <jats:p>Infants represent an understudied minority in sleep-disordered breathing (SDB) research and yet the disease can have a significant impact on health over the formative years of neurocognitive development that follow. Herein we report data on SDB in this population using a big data approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were abstracted using the Cerner Health Facts database. Demographics, sleep diagnoses, comorbid medication conditions, healthcare utilization, and economic outcomes are reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In a cohort of 68.7 million unique patients, over a 9-year period, there were 9,773 infants and young children with a diagnosis of SDB (obstructive sleep apnea [OSA], nonobstructive sleep apnea, and \u201cother\u201d sleep apnea) who met inclusion criteria, encompassing 17,574 encounters, and a total of 27,290 diagnoses across 62 U.S. health systems, 172 facilities, and 3 patient encounter types (inpatient, clinic, and outpatient). Thirty-nine percent were female. Thirty-nine percent were \u22641 year of age (6,429 infants), 50% were 1\u20132 years of age, and 11% were 2 years of age. The most common comorbid diagnoses were micrognathia, congenital airway abnormalities, gastroesophageal reflux, chronic tonsillitis\/adenoiditis, and anomalies of the respiratory system. Payor mix was dominated by government-funded entities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We have used a novel resource, large-scale aggregate, de-identified EHR data, to examine SDB. In this population, SDB is multifactorial, closely linked to comorbid medical conditions and may contribute to a significant burden of healthcare costs. Further research focusing on infants at highest risk for SDB can help target resources and facilitate personalized management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/sleep\/zsaa176","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T12:44:10Z","timestamp":1600087450000},"source":"Crossref","is-referenced-by-count":9,"title":["Small sleepers, big data: leveraging big data to explore sleep-disordered breathing in infants and young children"],"prefix":"10.1093","volume":"44","author":[{"given":"Zarmina","family":"Ehsan","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Mercy-Kansas City, Kansas City, MO"},{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Earl F","family":"Glynn","sequence":"additional","affiliation":[{"name":"Research Informatics, Children\u2019s Mercy Research Institute, Children\u2019s Mercy-Kansas City, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3140-6524","authenticated-orcid":false,"given":"Mark A","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO"},{"name":"Research Informatics, Children\u2019s Mercy Research Institute, Children\u2019s Mercy-Kansas City, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G","family":"Ingram","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Mercy-Kansas City, Kansas City, MO"},{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baha","family":"Al-Shawwa","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Mercy-Kansas City, Kansas City, MO"},{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"issue":"5","key":"2021021210384471300_CIT0001","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1093\/sleep\/16.5.409","article-title":"Clinical symptoms associated with brief obstructive sleep apnea in normal infants","volume":"16","author":"Kahn","year":"1993","journal-title":"Sleep"},{"issue":"3","key":"2021021210384471300_CIT0002","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.sleep.2005.11.003","article-title":"Sleep habits and risk factors for sleep-disordered breathing in infants and young toddlers in Louisville, Kentucky","volume":"7","author":"Montgomery-Downs","year":"2006","journal-title":"Sleep Med"},{"issue":"11","key":"2021021210384471300_CIT0003","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.5665\/sleep.3116","article-title":"Sleep disordered breathing in early childhood: quality of life for children and families","volume":"36","author":"Jackman","year":"2013","journal-title":"Sleep"},{"issue":"3","key":"2021021210384471300_CIT0004","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.otohns.2007.11.003","article-title":"Pediatric obstructive sleep apnea and quality of life: a meta-analysis","volume":"138","author":"Baldassari","year":"2008","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2021021210384471300_CIT0005","first-page":"109","article-title":"Obstructive sleep apnea in children: a critical update","volume":"5","author":"Tan","year":"2013","journal-title":"Nat Sci Sleep"},{"issue":"8","key":"2021021210384471300_CIT0006","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1164\/rccm.201108-1455CI","article-title":"Obstructive sleep apnea in infants","volume":"185","author":"Katz","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"2021021210384471300_CIT0007","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1378\/chest.108.3.610","article-title":"Inability of clinical history to distinguish primary snoring from obstructive sleep-apnea syndrome in children","volume":"108","author":"Carroll","year":"1995","journal-title":"Chest"},{"issue":"6","key":"2021021210384471300_CIT0008","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.otohns.2004.07.002","article-title":"Can history and physical examination reliably diagnose pediatric obstructive sleep apnea\/hypopnea syndrome? 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