Neck circumference percentile: A screening tool for pediatric obstructive sleep apnea
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Published on: December 6, 2016
Sherri Katz1, Kimmo Murto, Nicholas Barrowman
1Division of Respirology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Children with large neck circumference (NC) have a higher risk of obstructive sleep apnea (OSA). This finding is significant for males aged 12 and older, suggesting NC as a potential screening tool.
Area of Science:
- Pediatric Health
- Sleep Medicine
- Anthropometry
Background:
- Large neck circumference (NC) is a known risk factor for obstructive sleep apnea (OSA) in adults.
- Establishing age- and sex-specific reference ranges for NC in children is crucial for its use as a screening tool.
- Existing data lacks comprehensive NC reference ranges for pediatric populations.
Purpose of the Study:
- To develop age- and sex-specific reference ranges for neck circumference (NC) in children aged 6-17 years.
- To investigate the association between elevated NC and the risk of obstructive sleep apnea (OSA) in children.
- To evaluate NC as a potential screening tool for pediatric OSA.
Main Methods:
- Utilized a population-based dataset of 1,913 children to establish NC reference ranges.
- Collected NC data from 245 children aged 6-17 undergoing polysomnography.
- Analyzed the association between NC above the 95th percentile and OSA diagnosis, considering BMI and waist circumference thresholds.
Main Results:
- Children with NC above the 95th percentile showed a significantly increased risk of OSA (relative risk 1.7).
- The association between high NC and OSA was significant in males aged 12 years and older (relative risk 3.3).
- Elevated BMI (≥95th percentile) and waist circumference (>95th percentile) were not significant predictors of OSA in this cohort.
Conclusions:
- Neck circumference exceeding the 95th percentile for age and sex is a significant risk factor for OSA in children and youth.
- NC percentile is a more significant indicator for OSA risk in adolescent males than BMI.
- NC percentile shows promise as an additional, valuable screening tool for identifying children at risk of OSA.
Rationale:
Large neck circumference (NC) is associated with obstructive sleep apnea (OSA) in adults, especially males. Since NC changes with age and sex, a lack of reference ranges makes neck size difficult to assess as a screening tool in children.
Methods:
Using a population-based dataset of 1,913 children, we developed reference ranges for NC by age and sex for children aged 6-17 years. In this study, we collected NC data on 245 children aged 6-17 years presenting to the Children's Hospital of Eastern Ontario for polysomnography. The association between NC>the 95th percentile and OSA (total apnea-hypopnea-index>5 events/hr and/or obstructive-apnea-index ≥ 1 event/hr) was explored. Thresholds of BMI percentile and waist circumference were also examined.
Results:
Individuals with NC>95th percentile for age and sex had increased risk of OSA (relative risk 1.7 [95% CI 1.0-3.0], P=0.04), compared to those with NC ≤ 95th percentile. BMI ≥ 95th percentile gave similar results (relative risk 1.8 [95% CI 1.1-2.9], P=0.02). When examined by sex, the association was significant in males ≥ 12 years (relative risk 3.3 [95% CI 1.0-10.4], P=0.04), but not females (P=0.63). Neither BMI ≥ 95th percentile nor waist circumference>95th percentile was significant.
Conclusions:
Children and youth with NC>95th percentile for age and sex have significantly increased risk of OSA. This effect is significant in males ≥ 12 years, whereas BMI is not. NC percentile may be an additional screening tool for OSA in children and youth.
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