Adenoid size is related to severity but not the number of episodes of obstructive apnea in children,☆☆,,★★

Presented in part at the Annual Meeting of the American Thoracic Society, Boston, Mass-achusetts, May 1994.
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Abstract

Objective: The objective of this study was to determine the extent to which adenotonsillar hypertrophy contributes to the severity of obstructive sleep apnea (OSA) in children. Study design: Thirty-three consecutive children who were referred to a sleep disorders center for evaluation of suspected OSA had standard lateral neck roentgenography performed. Adenoid size was determined by measuring the adenoidal-nasopharyngeal (AN) ratio. Tonsil size was quantitated on physical examination. The severity of OSA was determined by full-night polysomnography in the sleep laboratory. Results: All of the patients reported snoring with trouble breathing, apneas, or both problems witnessed by a parent. The patients' respiratory disturbance index ranged from 0 to 95.3 (mean ± SD 12.5 ± 9.1). The patients' AN ratio ranged from 0.48 to 0.98 (0.76 ± 0.14); 30 (91%) of the 33 patients had AN ratios greater than published normal means, and 16 (48%) had AN ratios more than 2 standard deviations above published means. Although the AN ratio and tonsil size did not predict the number of apneas, a significant relationship was seen between the AN ratio and the duration of obstructive apneas (r = 0.48, p < 0.01). Obesity (percent ideal body weight) was the only independent predictor for the number of respiratory events per hour of sleep (r = 0.49, p < 0.01). Percent ideal body weight was also the major predictor of the lowest oxyhemoglobin saturation (r = –0.58, p < 0.0001), but the AN ratio also contributed to the variance in saturation, with a correlation coefficient (r) of 0.69 for the two factors (p < 0.0001). Conclusion: Lymphoid hyperplasia affects the severity of apnea more than the number of obstructive apneas. The pathophysiologic characteristics of OSA in children probably involve complex interactions between pharyngeal size and mechanics. (J Pediatr 1998;132:682-6)

Section snippets

METHODS

Thirty-three consecutive patients who were referred to the Sleep Disorders Center at Rainbow Babies and Childrens Hospital because of suspected OSA were evaluated with a physical examination, standard lateral neck roentgenography, and overnight PSG. Patients with obvious neurologic or craniofacial abnormalities were excluded.

RESULTS

Nineteen boys and 14 girls, ranging in age from 0.4 to 11.6 years, were studied. Their percent ideal body weight ranged from 72% to 250%. All of the patients reported snoring with trouble breathing or apneas witnessed by a parent, with a mean OSA score11 of 2.53 ± 2.09 SD. The patients' RDI ranged from 0 to 95.3 with a mean ± SD of 12.5 ± 19.1. The patients' AN ratio ranged from 0.48 to 0.98 with a mean of 0.76 ± 0.14. Thirty (91%) of the 33 patients had AN ratios greater than the mean reported

DISCUSSION

Obesity, not lymphoid hyperplasia, was the primary independent predictor of RDI in our sample of children who were referred for evaluation of OSA. Although adenoid size did not correlate with the number of respiratory events (RDI), the patients with larger adenoids had longer obstructive apneas and hence more severe oxyhemoglobin desaturation. These findings have important implications for understanding the pathophysiologic characteristics of OSA in children.

Marcus et al.12 showed that obese

Acknowledgements

We thank Juliann M. DiFiore for preparation of the figures and Therese Weaver and Linda L. Robinson for expert secretarial assistance.

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From the Division of Pulmonary Medicine, The Children's Regional Hospital, Robert Wood Johnson School of Medicine/UMDNJ, Camden, New Jersey, and the Pediatric Pulmonary Division and Sleep Disorders Center, Rainbow Babies and Childrens Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.

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Supported by a Summer Student Research Fellowship, Department of Pediatrics, Case Western Reserve University.

Reprint requests: Lee J. Brooks, MD, The Children's Regional Hospital, Robert Wood Johnson School of Medicine/UMDNJ, Education and Research Building, 401 Haddon Ave., Camden, NJ 08103.

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