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Predictive Value of Neck-to-Height Ratio in Children with Moderate/Severe Obstructive Sleep Apnea: A Retrospective

Tianxu Liu1, Xiaoyi Wang2, Wen Hu3

  • 1Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.

Nature and Science of Sleep
|April 27, 2026
PubMed

Insights

The neck-to-height ratio (NHR) shows promise as a simple screening tool for moderate/severe obstructive sleep apnea (OSA) in children over 10. NHR outperformed other measurements in predicting OSA, offering a more convenient diagnostic indicator.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Biometrics

Background:

  • Obstructive Sleep Apnea (OSA) is a prevalent condition in children, potentially causing significant health issues like growth restriction and neurocognitive impairment.
  • Current diagnostic methods like polysomnography (PSG) have limitations for widespread screening.
  • Existing screening tools lack sufficient accuracy and compliance, highlighting the need for simpler, reliable alternatives.

Purpose of the Study:

  • To systematically compare the predictive efficacy of neck-to-height ratio (NHR), waist-to-height ratio (WHtR), hip-to-height ratio (HHR), and BMI Z-score for identifying moderate/severe pediatric OSA.
  • To identify more accurate and convenient indicators for clinical screening of pediatric OSA.

Main Methods:

  • Retrospective analysis of data from 685 children aged 3-16 years who underwent PSG.
  • Receiver operating characteristic (ROC) analysis was employed to evaluate the discriminatory ability of NHR, WHtR, HHR, and BMI Z-score.
  • Analysis considered covariates such as age, gender, tonsil size, and adenoid size, with subgroup analyses performed.

Main Results:

  • NHR exhibited the highest predictive efficacy in the overall cohort (AUC=0.781), surpassing other tested indices.
  • In children over 10 years, NHR maintained strong predictive performance, with AUCs of 0.777 for boys and 0.913 for girls.
  • NHR demonstrated superior predictive value compared to WHtR, HHR, and BMI Z-score.

Conclusions:

  • NHR can serve as a valuable adjunctive screening tool for moderate/severe OSA in children over 10 years old.
  • The study suggests NHR offers moderate predictive value and outperforms traditional anthropometric indices for pediatric OSA screening.
  • NHR presents a promising, convenient alternative for early identification of OSA in pediatric populations.
Abstract

Keywords:
anthropometric indiceschildrenneck-to-height ratioobstructive sleep apneapolysomnography

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