TY - JOUR
T1 - Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates
AU - Weinstock, Tanya G.
AU - Rosen, Carol L.
AU - Marcus, Carole L.
AU - Garetz, Susan
AU - Mitchell, Ron B.
AU - Amin, Raouf
AU - Paruthi, Shalini
AU - Katz, Eliot
AU - Arens, Raanan
AU - Weng, Jia
AU - Ross, Kristie
AU - Chervin, Ronald D.
AU - Ellenberg, Susan
AU - Wang, Rui
AU - Redline, Susan
PY - 2014/2/1
Y1 - 2014/2/1
N2 - Study Objectives: There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities. Design: Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire. Setting: Clinical referral setting. Participants: Children, ages 5 to 9.9 y with OSAS. Measurements and Results: Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ≤ AHI <30 or 1 ≤ obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant. Conclusions: Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity. Clinical Trial Registration: Clinicaltrials.gov (#NCT00560859).
AB - Study Objectives: There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities. Design: Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire. Setting: Clinical referral setting. Participants: Children, ages 5 to 9.9 y with OSAS. Measurements and Results: Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ≤ AHI <30 or 1 ≤ obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant. Conclusions: Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity. Clinical Trial Registration: Clinicaltrials.gov (#NCT00560859).
KW - Adenotonsillectomy
KW - Apnea hypopnea index
KW - Disparities
KW - Obstructive sleep apnea syndrome
KW - Polysomnography
KW - Tobacco
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U2 - 10.5665/sleep.3394
DO - 10.5665/sleep.3394
M3 - Article
C2 - 24497655
AN - SCOPUS:84893510079
SN - 0161-8105
VL - 37
SP - 261
EP - 269
JO - Sleep
JF - Sleep
IS - 2
ER -