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Published on: December 6, 2016
Potential Anatomic Markers of Obstructive Sleep Apnea in Prepubertal Children
Chun Ting Au1, Kate Ching Ching Chan1, Kin Hung Liu2
1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Insights
Childhood obstructive sleep apnea (OSA) can be linked to hyoid bone position and lateral parapharyngeal wall thickness, not just enlarged tonsils. These anatomical features may help identify children at risk for OSA.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Medical Imaging
Background:
- Adenotonsillar hypertrophy is a primary cause of obstructive sleep apnea (OSA) in children.
- However, OSA can occur in children without enlarged tonsils, suggesting other anatomical factors are involved.
Purpose of the Study:
- To identify potential anatomical features, beyond tonsil size, associated with obstructive sleep apnea (OSA) in prepubertal children.
- To determine if specific anatomical measurements can serve as markers for childhood OSA risk.
Main Methods:
- A prospective study involving 6-11 year old children suspected of OSA.
- Methods included anthropometric measurements, polysomnography, tonsil evaluation, cephalometry, and sonographic measurement of lateral parapharyngeal wall (LPW) thickness.
- Regression analyses were used to associate anatomical measurements with OSA severity and identify risk markers.
Main Results:
- Forty-seven children with OSA and 43 controls were recruited.
- Lower hyoid bone position and greater LPW thickness were identified as risk factors for OSA.
- These anatomical markers were independently associated with higher obstructive apnea-hypopnea index (OAHI) and increased risk for moderate to severe OSA, even after adjusting for obesity and tonsil size.
Conclusions:
- Hyoid bone position and LPW thickness are significant anatomical markers for childhood OSA, independent of obesity and tonsil size.
- Cephalometry and LPW sonography may aid in screening and risk stratification for childhood OSA.
Study Objectives:
Adenotonsillar hypertrophy is the major cause of obstructive sleep apnea (OSA) in prepubertal children, but children without enlarged lymphoid tissues may still suffer from OSA. This study aimed to identify other potential anatomic features associated with childhood OSA.
Methods:
This prospective study took place between January 2010 and April 2014. Prepubertal children suspected to have OSA, aged 6 to 11 years, were recruited. They underwent anthropometric measurements, nocturnal polysomnography, tonsil size evaluation, x-ray cephalometry, and sonographic measurement of lateral parapharyngeal wall (LPW) thickness. Linear regression analyses were used to test for the association between anatomic measurements and OSA severity. Logistic regression analyses were used to identify potential anatomic markers for different cutoffs (obstructive apneahypopnea index (OAHI) ≥ 1 and ≥ 5 events/h) for OSA.
Results:
Forty-seven children with OSA (20 with moderate to severe disease) and 43 children for the control group were recruited. Sonographic measurement of LPW thickness and position of hyoid bone taken from x-ray cephalometry were risk factors associated with OSA. Linear regression analyses found that these two phenotypes were associated with OAHI. Multivariate models adjusted for age, sex, body mass index, z score, and tonsil size revealed that lower position of hyoid bone was independently associated with higher risk for OSA, whereas both lower position of hyoid bone and greater LPW thickness were associated with higher OAHI and also a higher risk for moderate to severe OSA.
Conclusions:
Position of hyoid bone and LPW thickness are anatomical markers of childhood OSA independent of obesity and tonsil size. Screening tools may include cephalometry and sonographic measurement of LPW to allow better delineation of OSA risk.
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