Associations between Adenotonsillar Hypertrophy, Age, and Obesity in Children with Obstructive Sleep Apnea

Abstract

ObjectiveTo investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA.MethodsIn total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age：toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression.ResultsThe AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk.ConclusionsAdenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence.

Sonographic measurement of palatine tonsil volume in children and comparison with actual volume

“…A study of 495 symptomatic pediatric patients in various age groups by Kang et al assessed tonsil size subjectively. They stated that tonsillar hypertrophy and obesity were significant factors in the OSAS etiology in children [16]. Similarly in our study, sonographic and actual volume values were higher in OSAS cases.…”

Clinical grading of tonsils: does it truly represent total tonsil volume in patients with recurrent tonsillitis

“…It is based on tonsillar airway obstruction. 5,6 Other grading system used are Point scale. 7 Friedman classified tonsil from 1-4, tonsil size 1 implies tonsils hidden within the pillars, tonsil size 2 implies the tonsil extending to the pillars, size 3 implies tonsils are beyond the pillars but not the midline, tonsil size 4 implies tonsils that extend to the midline in our study Friedman staging was followed.…”

Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences

“…118,119 Finally, it should be noted that the relationship between short sleep duration and obesity may be further complicated by the presence of obstructive sleep apnea. Not only is obesity emerging as an increasingly important risk factor for sleep-disordered breathing in children, 120 but obstructive sleep apnea may further exacerbate the inflammatory and metabolic consequences of both obesity and chronic sleep loss. 7,[121][122][123] Some evidence also suggests there may be gender differences in the strength of the association between obesity and sleep duration, with adolescent boys seeming to be at higher risk compared with girls in both cross-sectional and longitudinal studies using large data sets.…”