Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth

• Published in: Otolaryngology-head and neck surgery Vol. 158; no. 4; pp. 745 - 751
• Main Authors: Narang, Indra, Al-Saleh, Suhail, Amin, Reshma, Propst, Evan J., Bin-Hasan, Saadoun, Campisi, Paolo, Ryan, Clodagh, Kendzerska, Tetyana
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2018
• Subjects: obesity; obstructive sleep apnea; pediatrics; obstructive sleep apnea; obesity; pediatrics
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599817740349

Objectives
To determine whether neck:height ratio combined with adenoid and tonsillar size is a good predictive tool for obstructive sleep apnea in obese youth.
Study Design
Cross-sectional study.
Setting
Sleep clinics at the Hospital for Sick Children, Toronto, Canada.
Subjects and Methods
Consented obese individuals aged 8 to 18 years were recruited between 2013 and 2015. Anthropometric measures were obtained by a trained research coordinator in a standardized manner. Otolaryngologists evaluated adenoid and tonsil sizes. Obstructive sleep apnea was diagnosed with an overnight polysomnogram as an obstructive apnea-hypopnea index ≥2. Multivariable logistic regressions investigated the relationship between potential predictors and obstructive sleep apnea. The C-statistic measured the predictive ability.
Results
Of the 53 subjects (median age, 13 years; 55% males), 28 (53%) were diagnosed with obstructive sleep apnea, with a median index of 10.6 per hour. In a logistic regression controlling for adenoid size, enlarged tonsils were significantly associated with the presence of obstructive sleep apnea (P < .01). Adding neck:height ratio into the model improved the model predictive ability (C-index increased from 0.73 to 0.84). Controlling for tonsil and adenoid sizes, an increase in neck:height ratio was significantly associated with the presence of obstructive sleep apnea (P = .01).
Conclusion
Our study suggests that neck:height ratio combined with tonsillar hypertrophy may have a strong predictive ability for obstructive sleep apnea and may be useful in an ambulatory setting to screen obese youth at high risk. These findings should be confirmed in a larger study.