Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-02-2020 | Sleep Apnea | Miscellaneous

Associations among sleep symptoms, physical examination, and polysomnographic findings in children with obstructive sleep apnea

Authors: Xiao-hong Yan, Yu Zhao, Jing Wang, Tian Shen, Wen Yang, Yixin Qiao, Danni Cheng, Min Chen

Published in: European Archives of Oto-Rhino-Laryngology | Issue 2/2020

Abstract

Purpose

The relationships among PSG findings, OSA symptoms, and tonsil and adenoid size are not clear. In this study, we aimed to investigate the associations between pediatric OSA and tonsil and adenoid size using subjective (OSA-18 questionnaire) and objective (PSG) measurements.

Methods

101 consecutive patients aged from 2 to 12 years (mean age, 5.4 ± 2.2 years; boys, 72.3%) diagnosed with OSA were enrolled in two age groups (2–6 years group and 7–12 years group) and underwent PSG and lateral cephalometric radiography. Tonsil size and the adenoid–nasopharyngeal (A/N) ratio were determined. Quality of life and sleep symptoms were measured using the Chinese version OSA-18 questionnaire. Demographic and clinical data were obtained.

Results

75 and 26 patients were separately enrolled in 2–6 years group and 7–12 years group. In 2–6 years group, the multiple linear regression revealed that tonsil size and A/N ratio were associated with log apnea–hypopnea index (AHI), and the Spearman’s rank correlation reflected a positive correlation between log AHI and the OSA-18 sleep disturbance score (r = 0.362, P = 0.001). Log OSA-18 score was correlated with tonsil size (r = 0.349, P = 0.002) but not the A/N ratio in 2–6 years group. Finally, no significant associations were observed between log OSA-18 scores and log AHI in all patients.

Conclusion

As PSG stays the golden standard for diagnoses of pediatric OSA, physical examinations and quality-of-life assessments are needed to fully assess the impact of OSA on children.

Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, Marcus CL, Guire KE (2006) Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics 117(4):e769–778. https://doi.org/10.1542/peds.2005-1837 CrossRefPubMedPubMedCentral

Society. AT (1996) Standards and indications for cardiopulmonary sleep studies in children. American Thoracic Society. Am J Respir Crit Care Med 153(866):78

Xu Z, Gutiérrez-Tobal GC, Wu Y, Kheirandish-Gozal L, Ni X, Hornero R, Gozal D (2019) Cloud algorithm-driven oximetry-based diagnosis of obstructive sleep apnoea in symptomatic habitually snoring children. Eur Resp J. https://doi.org/10.1183/13993003.01788-2018 CrossRef

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 P (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):576–584. https://doi.org/10.1542/peds.2012-1671 CrossRefPubMed

Tarasiuk A, Simon T, Fau-Tal A, Tal A, Fau-Reuveni H, Reuveni H (2004) Adenotonsillectomy in children with obstructive sleep apnea syndrome reduces health care utilization. Pediatrics 113:351–356CrossRef

Torretta S, Rosazza C, Pace ME, Iofrida E, Marchisio P (2017) Impact of adenotonsillectomy on pediatric quality of life: review of the literature. Ital J Pediatr. https://doi.org/10.1186/s13052-017-0424-2 CrossRefPubMedPubMedCentral

Zhao G, Li Y, Wang X, Ding X, Wang C, Xu W, Han D (2018) The predictive value of polysomnography combined with quality of life for treatment decision of children with habitual snoring related to adenotonsillar hypertrophy. Eur Arch Otorhinolaryngol 275(6):1579–1586. https://doi.org/10.1007/s00405-018-4984-6 CrossRefPubMed

Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47(1):69–94. https://doi.org/10.1183/13993003.00385-2015 CrossRefPubMed

Pateron B, Marianowski R, Monteyrol PJ, Couloigner V, Akkari M, Chalumeau F, Fayoux P, Leboulanger N, Franco P, Mondain M (2018) French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 135(4):265–268. https://doi.org/10.1016/j.anorl.2018.04.005 CrossRefPubMed

10.

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.6772 CrossRefPubMedPubMedCentral

11.

Montgomery-Downs HE, O'Brien LM, Holbrook CR, Gozal D (2004) Snoring and sleep- disordered breathing in young children: Subjective and objective correlates. Sleep 27:87–94CrossRef

12.

Greenfeld M, Tauman R, DeRowe A, Sivan Y (2003) Obstructive sleep apnea syndrome due to adenotonsillar hypertrophy in infants. Int J Pediatr Otorhinolaryngol 67(10):1055–1060. https://doi.org/10.1016/s0165-5876(03)00182-4 CrossRefPubMed

13.

Frank Y, Kravath RE, Pollak CP, Weitzman ED (1983) Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations. Pediatrics 71(5):737–742PubMed

14.

Nolan J, Brietzke SE (2011) Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg 144(6):844–850. https://doi.org/10.1177/0194599811400683 CrossRefPubMed

15.

Howard NS, Brietzke SE (2009) Pediatric tonsil size: objective vs subjective measurements correlated to overnight polysomnogram. Otolaryngol Head Neck Surg 140(5):675–681. https://doi.org/10.1016/j.otohns.2009.01.008 CrossRefPubMed

16.

Wang JH, Chung Y-S, Jang YJ, Lee B-J (2009) Palatine tonsil size and its correlation with subjective tonsil size in patients with sleep-disordered breathing. Otolaryngol Head Neck Surg 141(6):716–721. https://doi.org/10.1016/j.otohns.2009.09.007 CrossRefPubMed

17.

Franco RA Jr, Rosenfeld RM, Rao M (2000) First place–resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 123(1 Pt 1):9–16. https://doi.org/10.1067/mhn.2000.105254 CrossRefPubMed

18.

Baldassari CM, Alam L, Vigilar M, Benke J, Martin C, Ishman S (2014) Correlation between REM AHI and quality-of-life scores in children with sleep-disordered breathing. Otolaryngol Head Neck Surg 151(4):687–691. https://doi.org/10.1177/0194599814547504 CrossRefPubMed

19.

Hwang SH, Guilleminault C, Park CS, Kim TW, Hong SC (2013) Usefulness of adenotonsillar size for prediction of severity of obstructive sleep apnea and flow limitation. Otolaryngol Head Neck Surg 149(2):326–334. https://doi.org/10.1177/0194599813490892 CrossRefPubMed

20.

Kang KT, Weng WC, Yeh TH, Lee PL, Hsu WC (2014) Validation of the Chinese version OSA-18 quality of life questionnaire in Taiwanese children with obstructive sleep apnea. J Formos Med Assoc 113(7):454–462. https://doi.org/10.1016/j.jfma.2012.10.002 CrossRefPubMed

21.

Fujioka M, Young LW, Girdany BR (1979) Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol 133(3):401–404CrossRef

22.

Brodsky L, Moore L, Stanievich JF (1987) A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 13(2):149–156CrossRef

23.

Kaditis AG, Alexopoulos EI, Hatzi F, Karadonta I, Chaidas K, Gourgoulianis K, Zintzaras E, Syrogiannopoulos GA (2007) 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-z CrossRef

24.

Li AM, Au CT, Ng SK, Abdullah VJ, Ho C, Fok TF, Ng PC, Wing YK (2009) Natural history and predictors for progression of mild childhood obstructive sleep apnoea. Thorax 65(1):27–31. https://doi.org/10.1136/thx.2009.120220 CrossRefPubMed

25.

Lam Y-Y, Chan EYT, Ng DK, Chan C-H, Cheung JMY, Leung S-Y, Chow P-y, Kwok K-l (2006) The correlation among obesity, apnea-hypopnea index, and tonsil size in children. Chest 130(6):1751–1756. https://doi.org/10.1378/chest.130.6.1751 CrossRefPubMed

26.

Dayyat E, Kheirandish-Gozal L, Sans Capdevila O, Maarafeya MMA, Gozal D (2009) Obstructive sleep apnea in children: relative contributions of body mass index and adenotonsillar hypertrophy. Chest 136(1):137–144. https://doi.org/10.1378/chest.08-2568 CrossRefPubMedPubMedCentral

27.

Tripuraneni M, Paruthi S, Armbrecht ES, Mitchell RB (2013) Obstructive sleep apnea in children. Laryngoscope 123(5):1289–1293. https://doi.org/10.1002/lary.23844 CrossRefPubMed

28.

Gozal D, Pope DW Jr (2001) Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics 107(6):1394–1399. https://doi.org/10.1542/peds.107.6.1394 CrossRefPubMed

29.

Isaiah A, Kiss E, Olomu P, Koral K, Mitchell RB (2018) Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy. Sleep Med 50:79–86CrossRef

30.

Marrugo Pardo G, Romero Moreno LF, Beltrán Erazo P, Villalobos Aguirre C (2018) Respiratory complications of adenotonsillectomy for obstructive sleep apnea in the pediatric population. Sleep Disord. https://doi.org/10.1155/2018/1968985 CrossRefPubMedPubMedCentral

31.

Malhotra A, Huang Y, Fogel RB, Pillar G, Edwards JK, Kikinis R, Loring SH, White DP (2002) The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 166(10):1388–1395CrossRef

32.

Ronen O, Malhotra A, Pillar G (2007) Influence of gender and age on upper-airway length during development. Pediatrics 120(4):e1028–e1034CrossRef

33.

Nguyen HL, Bonadurer GF 3rd, Tollefson MM (2018) Vascular malformations and health-related quality of life: a systematic review and meta-analysis. JAMA Dermatol 154(6):661–669. https://doi.org/10.1001/jamadermatol.2018.0002 CrossRefPubMedPubMedCentral

34.

Taylor HG, Bowen SR, Beebe DW, Hodges E, Amin R, Arens R, Chervin RD (2016) Cognitive effects of adenotonsillectomy for obstructive sleep apnea. Pediatrics. https://doi.org/10.1542/peds.2015-4458 CrossRefPubMedPubMedCentral

Title: Associations among sleep symptoms, physical examination, and polysomnographic findings in children with obstructive sleep apnea
Authors: Xiao-hong Yan
Yu Zhao
Jing Wang
Tian Shen
Wen Yang
Yixin Qiao
Danni Cheng
Min Chen
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Sleep Apnea
Polysomnography
Published in: European Archives of Oto-Rhino-Laryngology / Issue 2/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-019-05719-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Associations among sleep symptoms, physical examination, and polysomnographic findings in children with obstructive sleep apnea

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2020

The time course of nasal cytokine secretion in patients with aspirin-exacerbated respiratory disease (AERD) undergoing aspirin desensitization: preliminary data

Patients with acid, high-fat and low-protein diet have higher laryngopharyngeal reflux episodes at the impedance-pH monitoring

Risk factors for recurrence of laryngeal amyloidosis treated by microforceps and CO2 laser

Surgical repair of mechanical ventilation induced tracheoesophageal fistula

Evaluation of auditory temporal processing in patients fitted with bone-anchored hearing aids

A national survey of functional septorhinoplasty surgery performed in the United Kingdom: a clinician end-user questionnaire to assess current practice and help inform future practice