Zarmina Ehsan, MD

Medical Director, Pulmonary & Sleep Medicine Ambulatory Services; Associate Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Education Assistant Professor of Pediatrics, University of Kansas School of Medicine

Full Biography

Mark Hoffman, PhD

Chief Research Information Officer; Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Research Professor of Pediatrics, University of Kansas School of Medicine

Full Biography

Not all infants “sleep like a baby.” In fact, sleep-disordered breathing, or SDB, is the most common problem doctors see in infants.

SDB is a catchall term that can include everything from loud snoring to obstructive sleep apnea (OSA), a condition where part, or all, of the airway is blocked repeatedly during sleep. When a baby’s breathing is disrupted during sleep, the body thinks the infant is choking. The baby’s heart rate increases, blood pressure rises, the brain is aroused, and sleep gets interrupted.

As you might imagine, SDB can have a significant impact on a baby’s developing brain and body, but there isn’t much research into the condition.

Zarmina Ehsan, MD, Pediatric Pulmonology and Sleep Medicine, Children’s Mercy Kansas City, specializes in infant sleep disorders and identified a need for more research into this important topic. She wanted to know why babies develop SDB during infancy and beyond. She also wanted to help contribute to research into infant sleep disorders to help doctors learn more about which babies develop SDB and how to treat it.

But when it comes to research, the more patients included in a study, the better. Unfortunately, in sleep medicine, there are a limited number of infants available to study at any one hospital, like Children’s Mercy. “Most research studies conducted in single centers involve about 20 infants,” Dr. Ehsan said.

So, Dr. Ehsan joined forces with the data science team at the Children’s Mercy Research Institute led by Mark Hoffman, PhD, Chief Research Information Officer. The Children’s Mercy Research Institute is home to one of the most progressive and dynamic pediatric research programs in the world.

Together, Dr. Ehsan and Dr. Hoffman tapped into a huge database populated by 62 U.S. health systems across the country to conduct the first large study of SDB in infants. To do that, they used what’s called de-identified patient data. That means no information that could identify the patients, like name or address, was used in the study—only information about the infant’s diagnosis and treatment.

No other group has published research into infant sleep disorders using a database this large.

The result was the study, Small Sleepers, Big Data: Leveraging Big Data to Explore Sleep-Disordered Breathing in Infants and Young Children, published in the Journal of Sleep Medicine. Highlights included:

• Out 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, nonobstructive sleep apnea, and “other” sleep apnea) who were included in the study.
• 39% of patients were female; 39% were 1 year old (6,429); 50% were 1-2 years old; and 11% were 2 years old.
• Many of these infants had what are called co-morbid conditions—that’s another way of saying they had other medical problems along with SDB. These included problems like chronic tonsillitis, enlarged tonsils or adenoids, ear infections, jaw abnormalities, chromosomal abnormalities and conditions.
• The link between gastroesophageal reflux and obstructive sleep apnea in infants has been reported in the literature. This research found gastroesophageal reflux was more common in the study patients compared to the base population; but surprisingly, it didn’t appear to be a significant problem.

“No other group has published research into infant sleep disorders using a database this large,” Dr. Ehsan said. “We found the results of our research were in line with many smaller clinical studies.”

To figure out what all this means, Dr. Ehsan is working on more research targeting infants and young children with sleep disorders. Her research may one day help doctors at Children’s Mercy, and around the world, better diagnose and treat infant sleep disorders.