Related Experiment Video
Updated: May 3, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates
Tanya G Weinstock1, Carol L Rosen2, Carole L Marcus3
1Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Insights
Environmental tobacco smoke exposure and African American race significantly increase the severity of obstructive sleep apnea syndrome (OSAS) in children. Reducing exposure to secondhand smoke may help decrease OSAS severity.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Genetics and Environmental Health
Background:
- Obstructive sleep apnea syndrome (OSAS) severity in children is not fully understood.
- Identifying risk factors is crucial for effective management.
- Adenotonsillectomy (AT) is a common treatment for pediatric OSAS.
Purpose of the Study:
- To evaluate the relationship between OSAS severity and various factors in children considered for AT.
- To identify characteristics that predict increased OSAS severity.
Main Methods:
- Analysis of cross-sectional screening and baseline data from the Childhood Adenotonsillectomy Trial.
- Regression analysis to assess the association between the apnea hypopnea index (AHI) and risk factors.
- Inclusion of children aged 5 to 9.9 years with OSAS.
Main Results:
- African American race and environmental tobacco smoke (ETS) were significantly associated with increased AHI (approximately 20% increase each).
- Obesity and other factors were not found to be significant predictors of OSAS severity after adjustment.
- Univariate analyses showed associations with race, BMI z score, ETS, family income, and referral source.
Conclusions:
- Pediatric OSAS severity is significantly associated with race and ETS exposure.
- Environmental and potentially genetic factors play a role in OSAS severity.
- Reducing ETS exposure may be a key strategy to mitigate pediatric OSAS severity.
Study Objectives:
There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities.
Design:
Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire.
Setting:
Clinical referral setting.
Participants:
Children, ages 5 to 9.9 y with OSAS.
Measurements And Results:
Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ≤ AHI < 30 or 1 ≤ obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant.
Conclusions:
Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity.
Clinical Trial Registration:
Clinicaltrials.gov (#NCT00560859).
Related Concept Videos
01:21Sleep Apnea
The condition is more prevalent among...
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:26Tonsillitis II: Management
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...