Obstructive Sleep Apnea in Children: Relative Contributions of Body Mass Index and Adenotonsillar Hypertrophy

doi:10.1378/chest.08-2568

Chest

Volume 136, Issue 1, July 2009, Pages 137-144

https://doi.org/10.1378/chest.08-2568 Get rights and content

Background

The obesity epidemic has prompted remarkable changes in the proportion of obese children who are referred for habitual snoring. However, the contribution of obesity to adenotonsillar hypertrophy remains undefined.

Methods

In our study, 206 nonobese habitually snoring children with polysomnographically diagnosed obstructive sleep apnea (OSA) were matched for age, gender, ethnicity, and obstructive apnea-hypopnea index (OAHI) to 206 obese children. Size estimates of tonsils and adenoids, and Mallampati class scores were obtained, and allowed for the assessment of potential relationships between anatomic factors and obesity in pediatric OSA.

Results

The mean OAHI for the two groups was approximately 10.0 episodes/h total sleep time. There was a modest association between adenotonsillar size and OAHI in nonobese children (r = 0.22; p < 0.001) but not in obese children. The mean (± SEM) adenotonsillar size was larger in nonobese children (3.85 ± 0.16 vs 3.01 ± 0.14, respectively; p < 0.0001), and conversely Mallampati class scores were significantly higher in obese children (p < 0.0001).

Conclusion

The magnitude of adenotonsillar hypertrophy required for any given magnitude of OAHI is more likely to be smaller in obese children compared to nonobese children. Increased Mallampati scores in obese children suggest that soft-tissue changes and potentially fat deposition in the upper airway may play a significant role in the global differences in tonsillar and adenoidal size among obese and nonobese children with OSA.

Section snippets

Materials and Methods

This retrospective study was approved by the University of Louisville Human Research Committee, and it included as the first phase the database review of all habitually snoring children between 1 and 16 years of age who were evaluated with an overnight polysomnography (PSG) evaluation from October 2003 until September 2007 for suspected SDB. All patients fulfilling obesity criteria were initially identified. Of these, the charts of those children with PSG evidence of OSA were reviewed for

Cohort Selection

Initially, we identified all children who were obese and who fulfilled the diagnostic criteria for OSA (see following). This process allowed for the identification of 1,236 obese children with OSA of 2,217 obese habitually snoring children (55.7%). After the exclusion of incomplete records or of patients not fulfilling entry criteria, 206 obese children with OSA were retained for analyses. The database was then evaluated, and it identified 3,656 nonobese children who were referred during the

Discussion

In this study, we retrospectively identified two large cohorts of closely OAHI-matched pediatric patients with OSA who were also matched for age, gender, and ethnicity, and who differed only in their BMI. This approach, which aimed for further understanding of the relative contribution of obesity to OSA, revealed that adenotonsillar size is correlated with the severity of OSA in nonobese children but not among obese children. More importantly, however, our study shows that the magnitude of

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This research was supported by National Institutes of Health grants HL-065270, HL-086662, and HL-083075; the Commonwealth of Kentucky Research Challenge for Excellence Trust Fund; and the Children's Foundation Endowment for Sleep Research (to Dr. Gozal).

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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Chest

Original ResearchSleep MedicineObstructive Sleep Apnea in Children: Relative Contributions of Body Mass Index and Adenotonsillar Hypertrophy

Background

Methods

Results

Conclusion

Section snippets

Materials and Methods

Cohort Selection

Discussion

Chest

J Pediatr

Int J Pediatr Otorhinolaryngol

Chest

J Pediatr

J Pediatr

Clin Sleep Med

Pediatr Clin North Am

Otolaryngol Head Neck Surg

Sleep Med Rev

J Pediatr

Otolaryngol Head Neck Surg

Chest

Snoring, sleep disturbance, and behaviour in 4–5 year olds

Arch Dis Child

Neurocognitive and behavioral morbidity in children with sleep disorders

Curr Opin Pulm Med

Pediatric obstructive sleep apnea: complications, management, and long-term outcomes

Proc Am Thorac Soc

Metabolic alterations and systemic inflammation in obstructive sleep apnea among non-obese and obese pre-pubertal children

Am J Respir Crit Care Med

Ventilatory response to CO2 in children with obstructive sleep apnea from adenotonsillar hypertrophy

Anesth Analg

Adenotonsillar hypertrophy and skeletal morphology of children with obstructive sleep apnea syndrome

Acta Otolaryngol Suppl

Evaluation of the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea

ORL J Otorhinolaryngol Relat Spec

Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children

J Appl Physiol

Use of tonsil size in the evaluation of obstructive sleep apnoea

Arch Dis Child

Evaluation of clinical parameters in patients with obstructive sleep apnea and possible correlation with the severity of the disease

Eur Arch Otorhinolaryngol

Pathophysiology of pediatric obstructive sleep apnea

Proc Am Thorac Soc

Original Research
Sleep Medicine
Obstructive Sleep Apnea in Children: Relative Contributions of Body Mass Index and Adenotonsillar Hypertrophy

Ventilatory response to CO₂ in children with obstructive sleep apnea from adenotonsillar hypertrophy