Top

European Archives of Oto-Rhino-Laryngology

Published in:

Open Access 27-09-2023 | Bronchial Asthma | Miscellaneous

Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome

Authors: Lea Dékány, Viktória Molnár, András Molnár, András Bikov, Zsófia Lázár, Orsolya Bárdos-Csenteri, Pálma Benedek

Published in: European Archives of Oto-Rhino-Laryngology | Issue 12/2023

Abstract

Purpose

This study aimed to determine the effect of body mass index (BMI) percentile, asthma, sex, and age on the paediatric obstructive sleep apnoea (OSA) severity. Furthermore, to determine the possible predictive role of the BMI percentile and age in severe OSA.

Methods

This retrospective study included 921 children aged 2–18 years diagnosed with OSA by polysomnography. Analysis of Covariance (ANCOVA), Spearman’s correlation, Receiver Operating Characteristics (ROC) analyses were performed and area under the curve (AUC) was determined.

Results

We observed a significant association between a higher BMI percentile and the severity of OSA (p < 0.001, ρ = 0.15). The correlation also was significant under (p = 0.007, ρ = 0.11) and over 7 (p = 0.0002, ρ = 0.23) years of age. There was no association between the severity of OSA and the presence of asthma (p = 0.9) or sex (p = 0.891), respectively. Age was significantly related to OSA severity (p = 0.01, ρ = 0.08). Although both the BMI percentile (0.59 AUC [0.54–0.65]) and age (0.58 AUC [0.52–0.63]) predicted severe OSA, according to the sensitivity and specificity values of the ROC curve, the association presents a slight clinical relevance.

Conclusions

OSA severity is determined by the BMI percentile and age in children; however, these factors are unsuitable for predicting severe OSA in clinical practice. Based on our results, obesity is also a significant risk factor for OSA in younger children. Our study highlights that older, overweight, and obese children have a higher risk for severe OSA.

Walter LM, Shepherd KL, Yee A, Horne RSC (2020) Insights into the effects of sleep disordered breathing on the brain in infants and children: Imaging and cerebral oxygenation measurements. Sleep Med Rev. 50:101251. https://doi.org/10.1016/j.smrv.2019.101251CrossRefPubMed

American Thoracic Society (1996) Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 153(2):866–78. https://doi.org/10.1164/ajrccm.153.2.8564147CrossRef

Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Sheldon SH, Spruyt K, Ward SD, Lehmann C, Shiffman RN, American Academy of Pediatrics (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 130(3):576–84. https://doi.org/10.1542/peds.2012-1671CrossRefPubMed

Kanney ML, Harford KL, Raol N, Leu RM (2020) Obstructive sleep apnea in pediatric obesity and the effects of sleeve gastrectomy. Semin Pediatr Surg. 29(1):150887. https://doi.org/10.1016/j.sempedsurg.2020.150887CrossRefPubMed

Gulotta G, Iannella G, Vicini C, Polimeni A, Greco A, de Vincentiis M, Visconti IC, Meccariello G, Cammaroto G, De Vito A, Gobbi R, Bellini C, Firinu E, Pace A, Colizza A, Pelucchi S, Magliulo G (2019) Risk factors for obstructive sleep apnea syndrome in children: state of the art. Int J Environ Res Public Health 16(18):3235. https://doi.org/10.3390/ijerph16183235CrossRefPubMedPubMedCentral

Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC (2013) Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One. 8(10):e78666. https://doi.org/10.1371/journal.pone.0078666CrossRefPubMedPubMedCentral

Nittari G, Scuri S, Sagaro GG, Petrelli F, Grappasonni I (2020) Epidemiology of obesity in children and adolescents. Teamwork Healthcare. https://doi.org/10.5772/intechopen.93604CrossRef

Graw-Panzer KD, Muzumdar H, Jambhekar S, Goldstein NA, Rao M (2010) Effect of increasing body mass index on obstructive sleep apnea in children. Open Sleep J 3(1):19. https://doi.org/10.2174/1874620901003010019CrossRef

Kang KT, Lee PL, Weng WC, Hsu WC (2012) Body weight status and obstructive sleep apnea in children. Int J Obes (London) 36(7):920–924. https://doi.org/10.1038/ijo.2012.5CrossRef

10.

Konstantinopoulou S, Sideris GA, DelRosso LM (2016) The role of co-morbidities. Curr Probl Pediatr Adolesc Health Care 46(1):7–10. https://doi.org/10.1016/j.cppeds.2015.10.010CrossRefPubMed

11.

Wang R, Mihaicuta S, Tiotiu A, Corlateanu A, Ioan IC, Bikov A (2022) Asthma and obstructive sleep apnoea in adults and children—an up-to-date review. Sleep Med Rev. 61:101564. https://doi.org/10.1016/j.smrv.2021.101564CrossRefPubMed

12.

Benedek P, Lázár Z, Bikov A, Kunos L, Katona G, Horváth I (2013) Exhaled biomarker pattern is altered in children with obstructive sleep apnoea syndrome. Int J Pediatr Otorhinolaryngol 77(8):1244–1247. https://doi.org/10.1016/j.ijporl.2013.04.025CrossRefPubMed

13.

Alkhalil M, Schulman E, Getsy J (2009) Obstructive sleep apnea syndrome and asthma: what are the links? J Clin Sleep Med 5(1):71–78. https://doi.org/10.5664/jcsm.27397CrossRefPubMedPubMedCentral

14.

Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D (2008) Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc. 5(2):274–82. https://doi.org/10.1513/pats.200708-138MGCrossRefPubMedPubMedCentral

15.

Katz ES, D’Ambrosio CM (2010) Pediatric obstructive sleep apnea syndrome. Clin Chest Med. 31(2):221–34. https://doi.org/10.1016/j.ccm.2010.02.002CrossRefPubMed

16.

Barlow SE, Expert Committee (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 120(Suppl 4):S164-92. https://doi.org/10.1542/peds.2007-2329CCrossRefPubMed

17.

Andersen IG, Holm JC, Homøe P (2019) Obstructive sleep apnea in children and adolescents with and without obesity. Eur Arch Otorhinolaryngol. 276(3):871–878. https://doi.org/10.1007/s00405-019-05290-2CrossRefPubMed

18.

Kaditis AG, Alexopoulos EI, Hatzi F, Karadonta I, Chaidas K, Gourgoulianis K, Zintzaras E, Syrogiannopoulos GA (2008) Adiposity in relation to age as predictor of severity of sleep apnea in children with snoring. Sleep Breath. 12(1):25–31. https://doi.org/10.1007/s11325-007-0132-zCrossRefPubMed

19.

Benedek P, Balakrishnan K, Cunningham MJ, Friedman NR, Goudy SL, Ishman SL, Katona G, Kirkham EM, Lam DJ, Leboulanger N, Lee GS, Le Treut C, Mitchell RB, Muntz HR, Musso MF, Parikh SR, Rahbar R, Roy S, Russell J, Sidell DR, Sie KCY, Smith RJ, Soma MA, Wyatt ME, Zalzal G, Zur KB, Boudewyns A (2020) International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA). Int J Pediatr Otorhinolaryngol. 138:110276. https://doi.org/10.1016/j.ijporl.2020.110276CrossRefPubMed

20.

Bitners AC, Arens R (2020) Evaluation and management of children with obstructive sleep apnea syndrome. Lung. 198(2):257–270. https://doi.org/10.1007/s00408-020-00342-5CrossRefPubMedPubMedCentral

21.

Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S, Morielli A (2001) Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 138(6):838–44. https://doi.org/10.1067/mpd.2001.114474CrossRefPubMed

22.

Sateia MJ (2014) International classification of sleep disorders-third edition: highlights and modifications. Chest. 146(5):1387–1394. https://doi.org/10.1378/chest.14-0970CrossRefPubMed

23.

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM, Parikh SR, Shulman ST, Walner DL, Walsh SA, Nnacheta LC (2019) Clinical practice guideline: tonsillectomy in children (Update). Otolaryngol Head Neck Surg. 160(1_suppl):S1–S42. https://doi.org/10.1177/0194599818801757CrossRefPubMed

24.

Scott B, Johnson RF, Mitchell Md RB (2016) Obstructive sleep apnea: differences between normal-weight, overweight, obese, and morbidly obese children. Otolaryngol Head Neck Surg. 154(5):936–43. https://doi.org/10.1177/0194599816636626CrossRefPubMed

25.

Xu Z, Jiaqing A, Yuchuan L, Shen K (2008) A case-control study of obstructive sleep apnea-hypopnea syndrome in obese and nonobese chinese children. Chest. 133(3):684–9. https://doi.org/10.1378/chest.07-1611CrossRefPubMed

26.

Narayanan A, Yogesh A, Mitchell RB, Johnson RF (2020) Asthma and obesity as predictors of severe obstructive sleep apnea in an adolescent pediatric population. Laryngoscope 130(3):812–817. https://doi.org/10.1002/lary.28029CrossRefPubMed

27.

Julien JY, Martin JG, Ernst P, Olivenstein R, Hamid Q, Lemière C, Pepe C, Naor N, Olha A, Kimoff RJ (2009) Prevalence of obstructive sleep apnea-hypopnea in severe versus moderate asthma. J Allergy Clin Immunol 124(2):371–376. https://doi.org/10.1016/j.jaci.2009.05.016CrossRefPubMed

28.

Peroni DG, Pietrobelli A, Boner AL (2010) Asthma and obesity in childhood: on the road ahead. Int J Obes (Lond) 34(4):599–605. https://doi.org/10.1038/ijo.2009.273CrossRefPubMed

29.

Wang J, Zhao Y, Yang W, Shen T, Xue P, Yan X, Chen D, Qiao Y, Chen M, Ren R, Ren J, Xu Y, Zheng Y, Zou J, Tang X (2019) Correlations between obstructive sleep apnea and adenotonsillar hypertrophy in children of different weight status. Sci Rep 9(1):11455. https://doi.org/10.1038/s41598-019-47596-5CrossRefPubMedPubMedCentral

30.

Kirk V, Baughn J, D’Andrea L, Friedman N, Galion A, Garetz S, Hassan F, Wrede J, Harrod CG, Malhotra RK (2017) American academy of sleep medicine position paper for the use of a home sleep apnea test for the diagnosis of OSA in children. J Clin Sleep Med 13(10):1199–1203. https://doi.org/10.5664/jcsm.6772CrossRefPubMedPubMedCentral

31.

Hemmingsson E (2018) Early childhood obesity risk factors: socioeconomic adversity, family dysfunction, offspring distress, and junk food self-medication. Curr Obes Rep 7(2):204–209. https://doi.org/10.1007/s13679-018-0310-2CrossRefPubMedPubMedCentral

Title: Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome
Authors: Lea Dékány
Viktória Molnár
András Molnár
András Bikov
Zsófia Lázár
Orsolya Bárdos-Csenteri
Pálma Benedek
Publication date: 27-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Bronchial Asthma
Obesity
Obesity
Overweight
Underweight
Underweight
Polysomnography
Published in: European Archives of Oto-Rhino-Laryngology / Issue 12/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08237-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2023

New classification and surgical strategy for work type I congenital first branchial cleft anomalies in children

Thoracic skeletal muscle index is effective for CT-defined sarcopenia evaluation in patients with head and neck cancer

An evaluation of the test–retest reliability of the functional head impulse test in healthy young adults

Can functional septoturbinoplasty, with or without nasal valve suspension suture (FSTVS), alter the initial findings of drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea syndrome (OSAS)?

The potential of the Crystal Cam handheld gamma-camera for preoperative and intraoperative sentinel lymph node localization in early-stage oral cancer

Prognostic factors in pediatric cochlear implant: an outcome-based study