Upper Airway Structure and Body Fat Composition in Obese Children with Obstructive Sleep Apnea Syndrome

Arens, Raanan; Sin, Sanghun; Nandalike, Kiran; Rieder, Jessica; Khan, Unab I.; Freeman, Katherine; Wylie‐Rosett, Judith; Lipton, Michael L.; Wootton, David; McDonough, Joseph M.; Shifteh, Keivan

doi:10.1164/rccm.201008-1249oc

Cited by 133 publications

(109 citation statements)

References 40 publications

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“…12,15,32 In adolescents, visceral adiposity is associated with OSA risk in some, 32 although not all studies, 33 and enlarged neck circumference has been associated with increased upper airway collapsibility. 34 Recursive partitioning identified those with the highest BMI (> 99th percentile) as being a distinct sub-population.…”

Section: Discussionmentioning

confidence: 99%

Does Neck-to-Waist Ratio Predict Obstructive Sleep Apnea in Children?

Katz

Vaccani

Barrowman

et al. 2014

Journal of Clinical Sleep Medicine

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Objectives: Central adiposity and large neck circumference are associated with obstructive sleep apnea (OSA) in adults but have not been evaluated in children as predictors of OSA. Study objectives were to determine whether (1) anthropometric measures including neck-to-waist ratio are associated with OSA in older children; (2) body fat distribution, measured by neck-to-waist ratio, is predictive of OSA in overweight/obese children. Methods: Cross-sectional study involving children 7-18 years scheduled to undergo polysomnography at a tertiary care children's hospital. OSA was defi ned as total apnea-hypopnea index > 5 events/h and/or obstructive apnea index > 1 event/h. Recursive partitioning was used to select candidate predictors of OSA from: age, sex, height and weight percentile, body mass index (BMI) z-score, neck-to-waist ratio, tonsil size, and Mallampati score. These were then evaluated using log binomial models and receiver operator characteristic analysis. Results: Two hundred twenty-two participants were included; 133 (60%) were overweight/obese, 121 (55%) male,47 (21%) had OSA. Neck-to-waist ratio (relative risk [RR] 1.97 per 0.1 units, 95% CI 1.48 to 2.84) and BMI z-score (RR 1.63 per unit, 95% CI 1.30 to 2.05) were identifi ed as independent predictors of OSA. Considering only overweight/obese children, neckto-waist ratio (RR 2.16 per 0.1 units, 95% CI 1.79 to 2.59) and BMI z-score (RR 2.02 per unit, 95% CI 1.25 to 3.26) also independently predicted OSA. However, in children not overweight/obese, these variables were not predictive of OSA. Conclusions: Neck-to-waist ratio, an index of body fat distribution, predicts OSA in older children and youth, especially in those who were overweight/obese.

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Section: Discussionmentioning

confidence: 99%

Does Neck-to-Waist Ratio Predict Obstructive Sleep Apnea in Children?

Katz

Vaccani

Barrowman

et al. 2014

Journal of Clinical Sleep Medicine

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“…5,6 OSAS is frequently associated with benign adenotonsillar hypertrophy, but other possible causes such as the anatomy of the craniofacial anomalies, abnormal neuromuscular tone and respiratory disorders have also been reported. 2 A crucial factor in the genesis of OSAS is the increase in the soft-tissue volume. The speed of growth of the skeleton surrounding the upper airway is in fact lower than that of the characteristic soft tissues, in particular the lymphoid tissue.…”

Section: Introductionmentioning

confidence: 99%

The use of magnetic resonance imaging in the evaluation of upper airway structures in paediatric obstructive sleep apnoea syndrome: a systematic review and meta-analysis

Patini¹,

Arrica²,

Stasio³

et al. 2016

Dentomaxillofacial Radiology

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English assessing the use of MRI integrated with traditional polysomnography (PSG) among children up to 15 years of age affected by OSAS. The primary outcome to be evaluated was the efficacy of MRI in analyzing the upper airway total volume among healthy children compared with children affected by OSAS. Secondary outcomes were to compare the efficacy of MRI in analyzing the upper airway cross-sectional area in the areas adjacent to the adenoids and tonsils, adenoid and tonsil volume, and soft-tissue and maxillofacial bone parameters in the same sample. Results were expressed using a random-effects model and mean differences (MD) with 95% confidence intervals (CI). Results: The search yielded 1005 titles in total; the selection process narrowed to 3 titles, which were all assessed as indicating an unclear level of risk of bias. The meta-analysis found evidence of MRI effectiveness in evaluating differences in the upper airway total volume between paediatric patients affected by OSAS and paediatric patients not affected by OSAS (MD 20.56 cm 3 ; 95% CI: 21.05 to 20.07). Conclusions: Although MRI could be considered effective in evaluating upper airway structures in children affected by OSAS, based on the present evidence, PSG is still the golden standard and further studies are required to verify MRI reliability. Dentomaxillofacial Radiology (2016Radiology ( ) 45, 20160136. doi: 10.1259 Cite this article as: Patini R, Arrica M, Di Stasio E, Gallenzi P, Cordaro M. The use of magnetic resonance imaging in the evaluation of upper airway structures in paediatric obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Dentomaxillofac Radiol 2016; 45: 20160136.

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“…However, there was no correlation shown between the severity of OSAS and variation in body fat distribution. The same study identified an increase in tonsil volume in OSAS cases (10). In this study for the first time the correlation between tonsil volume measured with TCU in obese adolescents with hepatosteatosis was assessed and the tonsil volume was revealed to be higher in obese cases with hepatosteatosis.…”

Section: Discussionmentioning

confidence: 53%

“…In recent times studies have determined that transcervical ultrasound (TCU) is a practical method to measure the size of the palatine tonsils (8,9). Additionally, in the recent period there are studies evaluating the correlation of upper respiratory tract stenosis in obese children with OSAS and lymphoid tissue size and fat distribution in abdominal organs with MRI (10). To the best of our knowledge, there is no sonographic study assessing the correlation between fat accumulation in abdominal organs and tonsil size in the literature.The aim of this study is the measure the size of the palatine tonsils in adolescents with TCU and research the correlation with body mass index (BMI) and hepatosteatosis.…”

Section: Introductionmentioning

confidence: 99%