Risk factors of obstructive sleep apnea syndrome in obese early adolescents: a prediction model using scoring system

Supriyatno, Bambang; Said, Mohamed; Hermani, Bambang; Sjarif, Damayanti Rusli; Sastroasmoro, Sudigdo

doi:10.1016/s1526-0542(10)70160-3

Cited by 7 publications

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“…In the specific area of image analysis in OSAS, most published papers are restricted to correlative studies of finding image features that correlate with clinical parameters, which in the case of OSAS are chiefly (AHI and oxygen desaturation index (ODI) [ 1 , 28 , 37 , 38 ]. Reference [ 39 ] is an exception which proposed a predictive model for OSAS in obese adolescents by using a scoring system which is based on the sum of scores on tonsillar hypertrophy (T), adenoid hypertrophy (A), and neck circumference (NC). Adeno-tonsillar hypertrophy was determined based on paranasal sinus radiographic images.…”

Section: Discussionmentioning

confidence: 99%

MR Image Analytics to Characterize the Upper Airway Structure in Obese Children with Obstructive Sleep Apnea Syndrome

et al. 2016

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PurposeQuantitative image analysis in previous research in obstructive sleep apnea syndrome (OSAS) has focused on the upper airway or several objects in its immediate vicinity and measures of object size. In this paper, we take a more general approach of considering all major objects in the upper airway region and measures pertaining to their individual morphological properties, their tissue characteristics revealed by image intensities, and the 3D architecture of the object assembly. We propose a novel methodology to select a small set of salient features from this large collection of measures and demonstrate the ability of these features to discriminate with very high prediction accuracy between obese OSAS and obese non-OSAS groups.Materials and MethodsThirty children were involved in this study with 15 in the obese OSAS group with an apnea-hypopnea index (AHI) = 14.4 ± 10.7) and 15 in the obese non-OSAS group with an AHI = 1.0 ± 1.0 (p<0.001). Subjects were between 8–17 years and underwent T1- and T2-weighted magnetic resonance imaging (MRI) of the upper airway during wakefulness. Fourteen objects in the vicinity of the upper airways were segmented in these images and a total of 159 measurements were derived from each subject image which included object size, surface area, volume, sphericity, standardized T2-weighted image intensity value, and inter-object distances. A small set of discriminating features was identified from this set in several steps. First, a subset of measures that have a low level of correlation among the measures was determined. A heat map visualization technique that allows grouping of parameters based on correlations among them was used for this purpose. Then, through T-tests, another subset of measures which are capable of separating the two groups was identified. The intersection of these subsets yielded the final feature set. The accuracy of these features to perform classification of unseen images into the two patient groups was tested by using logistic regression and multi-fold cross validation.ResultsA set of 16 features identified with low inter-feature correlation (< 0.36) yielded a high classification accuracy of 96% with sensitivity and specificity of 97.8% and 94.4%, respectively. In addition to the previously observed increase in linear size, surface area, and volume of adenoid, tonsils, and fat pad in OSAS, the following new markers have been found. Standardized T2-weighted image intensities differed between the two groups for the entire neck body region, pharynx, and nasopharynx, possibly indicating changes in object tissue characteristics. Fat pad and oropharynx become less round or more complex in shape in OSAS. Fat pad and tongue move closer in OSAS, and so also oropharynx and tonsils and fat pad and tonsils. In contrast, fat pad and oropharynx move farther apart from the skin object.ConclusionsThe study has found several new anatomic bio-markers of OSAS. Changes in standardized T2-weighted image intensities in objects may imply that intrinsic tissue composition undergoe...

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Section: Discussionmentioning

confidence: 99%

MR Image Analytics to Characterize the Upper Airway Structure in Obese Children with Obstructive Sleep Apnea Syndrome

et al. 2016

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“…Pada dewasa, obesitas, usia lanjut, serta merokok merupakan faktor risiko utama OSAS, sedangkan pada anak faktor risiko tertinggi adalah hipertrofi tonsil dan adenoid, disproporsi wajah (misalnya sindrom Pierre Robin, sindrom Apert), dan obesitas (pada remaja). 1,7,8…”

Section: Faktor Risikounclassified

“…Di Indonesia, pemeriksaan ini belum merata sehingga diperlukan suatu pemeriksaan alternatif, seperti poligrafi, pulse-oxymetri, rekaman video, dan rekaman suara (tape-recorder) dengan berbagai kekurangan dan kelebihannya. 3,[8][9][10] Pemeriksaan PSG dapat membedakan apnea atau hipopnea yang terjadi karena sumbatan jalan napas atau karena kelainan sentral sedangkan pemeriksaan penunjang yang lain tidak dapat membedakannya. Penentuan jenis apnea atau hipopnea penting untuk tata laksana selanjutnya.…”

Section: Diagnosisunclassified

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Mendengkur pada Anak: kapan waktu yang tepat untuk dilakukan tonsiloadenoidektomi?

Supriyatno

2016

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Mendengkur atau mengorok adalah suara nyaring yang keluar dari saluran respiratori atas sebagai hasil getaran palatum molle dan uvula. Mendengkur bukanlah suatu diagnosis, melainkan gejala yang harus dicari diagnosisnya. Mendengkur perlu diwaspadai karena dapat menimbulkan masalah respiratori di kemudian hari, dan terbagi dalam dua kelompok besar, yaitu occasional snoring dan habitual snoring. Spektrum mendengkur terdiri dari ringan hingga berat, yaitu primary snoring, upper airway resistance syndrome, obstructive hypoventilation, dan obstructive sleep apnea syndrome (OSAS). Pemeriksaan baku emas untuk membedakan spektrum mendengkur tersebut adalah polisomnografi (PSG), namun pemeriksaan ini belum merata di seluruh daerah. Sebagai alternatif, pemeriksaan lain yang dapat dilakukan adalah poligrafi, pulse-oximetri, rekaman video, dan tape recorder. Faktor risiko utama OSAS pada anak adalah hipertrofi tonsil dan/atau adenoid, dengan demikian kecenderungan tata laksana saat ini adalah tonsiloadenoidektomi (TA). Sebelum tindakan TA, kortikosteroid intranasal, selama 4-8 minggu, dapat diberikan untuk menurunkan ukuran tonsil dan/atau adenoid. Indikasi TA adalah OSAS sedang dan berat pada anak, tonsilitis akut yang berulang, abses peritonsil, dan tersangka keganasan. Pada daerah dengan fasilitas terbatas, TA dapat dipertimbangkan pada habitual snoring yang tidak respons dengan pemberian kortikosteroid intranasal selama 8 minggu. Setelah dilakukan TA, pemantauan lebih lanjut perlu dilakukan untuk melihat proses catch up terhadap pertumbuhan dan perkembangan anak

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“…A Canadian cross‐sectional study of 222 children aged 7–18 years showed neck‐to‐waist ratio was predictive of OSA especially in those who were overweight or obese . An observational study of 110 obese Indonesian children aged 10–12 years created a scoring system based on tonsillar hypertrophy, adenoidal hypertrophy and neck circumference, which showed a sensitivity and specificity of 62% and 100% in diagnosing OSA . A prospective study in the United States showed visceral fat distribution measured by magnetic resonance spectroscopy in obese children aged 5–18 years was independently predictive of OSA severity .…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea in children with obesity

Kassim

Harris

Leong

et al. 2016

J Paediatrics Child Health

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Risk factors of obstructive sleep apnea syndrome in obese early adolescents: a prediction model using scoring system

Cited by 7 publications

References 0 publications

MR Image Analytics to Characterize the Upper Airway Structure in Obese Children with Obstructive Sleep Apnea Syndrome

MR Image Analytics to Characterize the Upper Airway Structure in Obese Children with Obstructive Sleep Apnea Syndrome

Mendengkur pada Anak: kapan waktu yang tepat untuk dilakukan tonsiloadenoidektomi?

Obstructive sleep apnoea in children with obesity

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