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Red cell distribution width: a new tool for the severity prediction of sleep apnoea syndrome in children
Daniel Morell-Garcia1,2, Núria Toledo-Pons2,3, Pilar Sanchis2
1Dept of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
Insights
Red cell distribution width (RDW) can help screen for moderate-to-severe obstructive sleep apnoea (OSA) in children. Elevated RDW and low MCHC levels may predict OSA severity in pediatric patients.
Area of Science:
- Pediatric Sleep Medicine
- Hematology
- Biomarker Discovery
Background:
- Red cell distribution width (RDW) indicates red blood cell size variation.
- Increased RDW is linked to obstructive sleep apnoea (OSA) and cardiovascular mortality in adults.
- The role of RDW as a biomarker in pediatric OSA requires further investigation.
Purpose of the Study:
- To evaluate Red cell distribution width (RDW) as a potential biomarker for screening moderate-to-severe obstructive sleep apnoea (OSA) in children.
- To determine the association between RDW and OSA severity in pediatric patients.
- To explore the utility of RDW in predicting OSA severity in children.
Main Methods:
- Observational study involving snoring children who underwent polysomnography.
- Classification of patients into simple snorers, mild OSA, and moderate-to-severe OSA groups based on Apnoea-Hypopnoea Index (AHI).
- Blood analyses including complete blood count (CBC) and C-reactive protein (CRP) were performed.
Main Results:
- A predictive model for severe pediatric OSA (AHI ≥5 events/h) was developed using RDW >13.1% and Mean Corpuscular Hemoglobin Concentration (MCHC) <34.9 g/dL, with an Area Under the Curve (AUC) of 0.657.
- RDW showed significant negative associations with minimum oxygen saturation and positive associations with AHI, oxygen desaturation index, and arousal index.
- Differences in eosinophil count and CRP were observed among the OSA severity groups.
Conclusions:
- RDW is a significant biomarker associated with OSA severity in children.
- Combining RDW and MCHC measurements offers a simple yet effective tool for predicting the severity of pediatric OSA in snoring children.
- These findings suggest RDW's potential role in the early screening and risk stratification of pediatric OSA.
Introduction:
Red cell distribution width (RDW) is a parameter included in the complete blood count which informs about the size of the circulating red blood cell population and its distribution. In adults, an increase in RDW was shown to be associated both with obstructive sleep apnoea (OSA) and with an increase in cardiovascular mortality. The aim of this study was to determine whether RDW is a potential biomarker for screening children with moderate-severe OSA.
Methods:
An observational study in snoring patients was performed. All patients underwent a sleep study and were classified either as simple snorers (apnoea-hypopnoea index (AHI) <1 event·h-1) or as patients with OSA (mild AHI ≥1 to <5 events·h-1; moderate-severe AHI ≥5 events·h-1). Blood analyses (complete blood count and C-reactive protein) were performed for every individual.
Results:
A total of 175 individuals were recruited. The mean age was 8.3±3.6 years. Correlation studies between RDW and several sleep-related parameters showed negative significant associations with minimum oxygen saturation, and positive significant associations with oxygen desaturation index (≥3% and ≥4%), AHI and the arousal index. A predictive model for paediatric severe OSA (AHI ≥5 events·h-1) was found based on mean corpuscular haemoglobin concentration (MCHC) <34.9 g·dL-1 and RDW >13.1% values, adjusting for body mass index z-score and age (area under the curve 0.657; p=0.004). In addition, differences were found in eosinophil count and C-reactive protein concentrations among the three subgroups.
Conclusions:
In children, RDW stands out as a biomarker associated with the severity of OSA. The use of RDW and MCHC could be a simple but useful tool for the severity prediction of paediatric OSA in snoring patients.
