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Updated: May 11, 2026
Image Acquisition using Portable Sonography for Emergency Airway Management
Published on: September 28, 2022
Correlations between polysomnographic and lateral airway radiograph measurements in paediatric obstructive sleep
Karen Waters1, Chenda Kol-Castro, Ajoy Varghese
1Department of Respiratory Support Service, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. Karen.Waters@health.nsw.gov.au
Insights
Lateral airway radiography (LAR) shows moderate to high inter-rater reliability for assessing adenoidal hypertrophy. However, LAR cannot reliably predict obstructive sleep apnoea (OSA) severity in children.
Area of Science:
- Pediatric Radiology
- Sleep Medicine
- Otolaryngology
Background:
- Adenoidal hypertrophy is a common cause of pediatric obstructive sleep apnoea (OSA).
- Accurate assessment of adenoid size is crucial for diagnosing and managing OSA in children.
Purpose of the Study:
- To evaluate the efficacy of lateral airway radiography (LAR) in assessing adenoidal hypertrophy.
- To correlate LAR findings with the severity of obstructive sleep apnoea (OSA) determined by polysomnography (PSG).
Main Methods:
- A cohort study involving 72 children evaluated for OSA.
- Children underwent both lateral airway radiography (LAR) and overnight polysomnography (PSG).
- Four standardized LAR assessment methods were used by five blinded assessors, with inter-rater reliability analyzed.
Main Results:
- Inter-rater reliability for LAR methods ranged from moderate to high (0.51-0.96).
- The anterior airway measurement (Hibbert method) showed the best correlation with PSG-determined obstructive apnoea-hypopnea index (r=-0.25) and minimum oxygen saturation (r=0.25).
- Despite moderate correlations, LAR methods were not found to be predictive of OSA severity.
Conclusions:
- While LAR methods demonstrate good reliability for assessing adenoid size, they are insufficient as predictors of OSA severity in children.
- Further research may be needed to refine imaging techniques or identify other predictive markers for pediatric OSA.
Aim:
To evaluate the ability of lateral airway radiography (LAR) to assess adenoidal hypertrophy in children and correlate with the severity of obstructive sleep apnoea (OSA).
Methods:
This cohort study was undertaken in 72 children who presented consecutively for evaluation of OSA to the outpatients of the Children's Hospital at Westmead. All children had LAR and overnight polysomnography (PSG). Five assessors, with varying experience, were blinded to the PSG results and independently analysed the LAR. Inter-rater reliability was determined for four published assessment methods; Hibbert, Johannesson, Fujioka and Cohen and Konak. We then compared the four LAR results with PSG-determined criteria for OSA.
Results:
Using intraclass correlations, inter-rater correlations were moderate to high for all four standardised evaluations of LAR with values ranging from 0.51 to 0.96. With the radiologist taken as the 'gold standard', individual assessors ranged from 0.05 to 0.91. LAR correlated best with PSG determined obstructive apnoea hypopnea index and minimum oxygen saturation for the anterior airway measurement (Hibbert) with r-values of -0.25 and 0.25 respectively (P < 0.05).
Conclusion:
Amongst four methods of evaluating adenoid size, the anterior airway size correlated best with PSG variables of obstructive respiratory index and minimum oxygen saturation. However, the methods are not able to be used as a predictor for OSA.
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