TY - JOUR
T1 - Predictors of obstructive sleep apnea severity in adolescents
AU - Baker, Mark
AU - Scott, Brian
AU - Johnson, Romaine F.
AU - Mitchell, Ron B.
N1 - Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
PY - 2017/5
Y1 - 2017/5
N2 - IMPORTANCE: Untreated obstructive sleep apnea has severe health consequences, yet little is known about predictors of sleep apnea severity in the adolescent population. OBJECTIVE: To evaluate clinical and demographic factors associated with obstructive sleep apnea severity in adolescents. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case series of 224 children (53% male), ages 12 to 17 years who underwent polysomnography from January 1, 2013, to June 4, 2015. The study was carried out in a large tertiary referral children's hospital associated with an academic medical center in Dallas, Texas. Children were excluded if they were missing clinical data (eg, tonsil size), had major comorbidities (eg, chromosomal abnormalities), or had previously undergone tonsillectomy and adenoidectomy. The mean (SD) age was 14.6 (1.7) years (range, 12.0-17.9 years), and the patients were 55% Hispanic, 30% African American, 13% white, and 2% other. EXPOSURES: Electronic medical records were reviewed for demographic, clinical, and polysomnographic parameters. MAIN OUTCOMES AND MEASURES Correlation between demographic and clinical characteristics and the apnea hypopnea index. RESULTS: In 224 adolescents (53% male) aged 12 to 17 years, the mean (SD) apnea hypopnea index was 14.9 (28.7) (range, 0.0-187.7) and was positively correlated with CDC-defined weight categories (P =.04) and tonsillar hypertrophy (P <.001). Sex, ethnicity, and age were not associated with the apnea hypopnea index. Severe obstructive sleep apnea (apnea hypopnea index >10) was more commonin males (OR, 1.8; 95% CI, 1.0-3.2), patients with tonsillar hypertrophy (OR, 3.2; 95% CI, 1.8-5.8), and patients in a heavier CDC weight class (OR, 2.0; 95% CI, 1.3-3.2). Age and ethnicity did not predict severe obstructive sleep apnea. CONCLUSIONS AND RELEVANCE: Obstructive sleep apnea in adolescents is associated with obesity and tonsillar hypertrophy in this study. Severe obstructive sleep apnea is more likely in adolescents who are male or obese, or who have tonsillar hypertrophy. This study supports routine polysomnography in obese male adolescents with tonsillar hypertrophy and symptoms of sleep-disordered breathing to screen for and treat severe obstructive sleep apnea.
AB - IMPORTANCE: Untreated obstructive sleep apnea has severe health consequences, yet little is known about predictors of sleep apnea severity in the adolescent population. OBJECTIVE: To evaluate clinical and demographic factors associated with obstructive sleep apnea severity in adolescents. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case series of 224 children (53% male), ages 12 to 17 years who underwent polysomnography from January 1, 2013, to June 4, 2015. The study was carried out in a large tertiary referral children's hospital associated with an academic medical center in Dallas, Texas. Children were excluded if they were missing clinical data (eg, tonsil size), had major comorbidities (eg, chromosomal abnormalities), or had previously undergone tonsillectomy and adenoidectomy. The mean (SD) age was 14.6 (1.7) years (range, 12.0-17.9 years), and the patients were 55% Hispanic, 30% African American, 13% white, and 2% other. EXPOSURES: Electronic medical records were reviewed for demographic, clinical, and polysomnographic parameters. MAIN OUTCOMES AND MEASURES Correlation between demographic and clinical characteristics and the apnea hypopnea index. RESULTS: In 224 adolescents (53% male) aged 12 to 17 years, the mean (SD) apnea hypopnea index was 14.9 (28.7) (range, 0.0-187.7) and was positively correlated with CDC-defined weight categories (P =.04) and tonsillar hypertrophy (P <.001). Sex, ethnicity, and age were not associated with the apnea hypopnea index. Severe obstructive sleep apnea (apnea hypopnea index >10) was more commonin males (OR, 1.8; 95% CI, 1.0-3.2), patients with tonsillar hypertrophy (OR, 3.2; 95% CI, 1.8-5.8), and patients in a heavier CDC weight class (OR, 2.0; 95% CI, 1.3-3.2). Age and ethnicity did not predict severe obstructive sleep apnea. CONCLUSIONS AND RELEVANCE: Obstructive sleep apnea in adolescents is associated with obesity and tonsillar hypertrophy in this study. Severe obstructive sleep apnea is more likely in adolescents who are male or obese, or who have tonsillar hypertrophy. This study supports routine polysomnography in obese male adolescents with tonsillar hypertrophy and symptoms of sleep-disordered breathing to screen for and treat severe obstructive sleep apnea.
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U2 - 10.1001/jamaoto.2016.4130
DO - 10.1001/jamaoto.2016.4130
M3 - Article
C2 - 28241176
AN - SCOPUS:85019831799
SN - 2168-6181
VL - 143
SP - 494
EP - 499
JO - JAMA Otolaryngology - Head and Neck Surgery
JF - JAMA Otolaryngology - Head and Neck Surgery
IS - 5
ER -