The Use of Clinical Parameters to Predict Obstructive Sleep Apnea Syndrome Severity in Children

Abstract

IMPORTANCE It is important to distinguish children with different levels of severity of obstructive sleep apnea syndrome (OSAS) preoperatively using clinical parameters. This can identify children who most need polysomnography (PSG) prior to adenotonsillectomy (AT). OBJECTIVE To assess whether a combination of factors, including demographics, physical examination findings, and caregiver reports from questionnaires, can predict different levels of OSAS severity in children. DESIGN, SETTING, AND PARTICIPANTS Baseline data from 453 children from the Childhood Adenotonsillectomy (CHAT) study were analyzed. Children 5.0 to 9.9 years of age with PSG-diagnosed OSAS, who were considered candidates for AT, were included. INTERVENTIONS Polysomnography for diagnosis of OSAS. MAIN OUTCOMES AND MEASURES Linear or logistic regression models were fitted to identify which demographic, clinical, and caregiver reports were significantly associated with the apnea hypopnea index (AHI) and oxygen desaturation index (ODI). RESULTS Race (African American), obesity (body mass index z score > 2), and the Pediatric Sleep Questionnaire (PSQ) total score were associated with higher levels of AHI and ODI (P = .05). A multivariable model that included the most significant variables explained less than 3% of the variance in OSAS severity as measured by PSG outcomes. Tonsillar size and Friedman palate position were not associated with increased AHI or ODI. Models that tested for potential effect modification by race or obesity showed no evidence of interactions with any clinical measure, AHI, or ODI (P > .20 for all comparisons). CONCLUSIONS AND RELEVANCE This study of more than 450 children with OSAS identifies a number of clinical parameters that are associated with OSAS severity. However, information on demographics, physical findings, and questionnaire responses does not robustly discriminate different levels of OSAS severity. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00560859

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

“…The association between tonsillar size evaluated subjectively and OSAS severity as determined by polysomnography is weak at best. High-quality studies suggest no association (meta-analysis) (class I) [17,18]. Grading systems for pharyngeal anatomy, such as the Friedman palate position or the Mallampati score, are not related to AHI in children with symptoms of SDB (class I and IV) [19].…”

The Adenoid Microbiome in Recurrent Acute Otitis Media and Obstructive Sleep Apnea

“…Adenoid specimens were obtained from children between 2 and 11 years old who were undergoing routine adenoidectomy for RAOM (n=7) or OSA, without otitis media (n=13). The diagnoses of RAOM and OSA were based on conventional criteria [22,23] . Subjects were otherwise healthy with no other significant co-morbidities, such as craniofacial disorders or immunologic deficiencies.…”

Sleep disordered breathing in childhood

“…Several different questionnaires are used for diagnostic purposes in routine clinical practice. MITCHELL et al [6] analysed baseline data from 453 children from the Childhood Adenotonsillectomy (CHAT) study. Children aged 5.0-9.9 years with OSAS, who were considered candidates for adenotonsillectomy, were included in the study.…”

“…MITCHELL et al [6] performed a study including >450 children to identify which children most need PSG prior to adenotonsillectomy. They showed that information on demographics, physical findings and questionnaire responses does not robustly discriminate different levels of OSAS severity.…”