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Association of adenoid hypertrophy and clinical parameters with preoperative polygraphy in pediatric patients
Alexander Lein1, Hasan Altumbabic2, Miralem Đešević3
1Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Insights
Adenoid-choanal ratio and clinical symptoms are reliable predictors of obstructive sleep apnea (OSAS) severity in children aged 3-14. Clinical symptoms alone predict OSAS severity in schoolchildren.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Respiratory Physiology
Background:
- Adenotonsillar hypertrophy is a primary cause of pediatric obstructive sleep apnea (OSAS).
- Assessing adenoid hypertrophy can be challenging, often relying on clinical symptoms for surgical indications.
- Limited data exists on correlating clinical factors with OSAS severity in children undergoing adenoidectomy.
Purpose of the Study:
- To evaluate the relationship between patient characteristics, adenoid hypertrophy, and clinical symptoms with OSAS severity.
- To identify predictors of OSAS severity in pediatric patients considered for adenoidectomy.
Main Methods:
- Retrospective chart review of pediatric patients undergoing polygraphy (PG) for OSAS diagnosis (2018-2023).
- Adenoid hypertrophy assessed via adenoid-choanal ratio (AC-ratio); clinical symptoms via a standardized score (CS).
- Linear regression analysis used to correlate AC-ratio, CS, and BMI with the apnea-hypopnea index (AHI).
Main Results:
- Significant correlations found between CS and BMI (p=0.026), and CS and AC-ratio (p<0.001).
- Both AC-ratio and CS significantly associated with AHI in univariable and multivariable analyses for the total and preschool cohorts.
- CS remained the sole significant predictor of AHI in the school-aged cohort.
Conclusions:
- Adenoid-choanal ratio and clinical symptoms are effective predictors of OSAS severity in children aged 3-14.
- Clinical symptoms are the primary predictor of OSAS severity in older children (school cohort).
- Further research is recommended to validate these findings.
Background:
Adenotonsillar hypertrophy is the most frequent cause for obstructive sleep apnea (OSAS) in children. In patients with small tonsils and where adenoid size cannot be assessed, the indication for adenoidectomy often relies on clinical symptoms. However, data on the association of clinical parameters and adenoid hypertrophy with OSAS severity in children undergoing an adenoidectomy is sparse.
Aim:
To investigate the correlation of patient characteristics, adenoid hypertrophy, and clinical symptoms with OSAS severity in pediatric patients indicated for an adenoidectomy.
Methods:
We performed a retrospective chart review of all pediatric patients at our tertiary referral center between 2018 and 2023 who underwent polygraphy (PG) for OSAS diagnostics. Adenoid hypertrophy was assessed as adenoid-choanal ratio (AC-ratio) via nasal endoscopy and clinical symptom score (CS) via physical examination and parental survey. We included all symptomatic children with mild to severe OSAS (apnea-hypopnea index (AHI) ≥ 1). Exclusion criteria were obesity according to BMI and/or the presence of systemic diseases. The patients were divided according to age in a preschool and school cohort. Patient characteristics and PG data were compared between both groups. Linear regression analysis was used to investigate the association of AC-ratio, CS and BMI with the AHI.
Results:
A total of 121 patients were identified of which 81 were included in our study, resulting in 42 and 39 patients from 3-5 and 6-14 years of age, respectively. We observed a significant correlation between CS and BMI (p = 0.026) and the CS and AC-ratio (p < 0.001). Univariable regression analysis showed significant association of the AC-ratio and CS with AHI-score for the total (p < 0.001), the preschool (p < 0.001), and the school cohort (p < 0.001). In multivariable regression analysis, the significant association of AC-ratio and CS remained in the total (p = 0.014; p < 0.001), and the preschool cohort (p = 0.029; p = 0.002). However, only the CS remained as positive predictor in the school cohort.
Conclusion:
AC-ratio and clinical symptoms seem to be reliable predictors for OSAS severity in patients between 3-14 years of age. Moreover, only clinical symptoms were associated with OSAS severity in schoolchildren. Future investigation should contribute to the validation of our results.
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