A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study

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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“…11,12 In adults, large neck circumference (NC) identifi es individuals at increased risk of OSA. [13][14][15][16] One prospective study has…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

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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“…[2][3][4][5] Worldwide, studies have found a high level of clinically undiagnosed OSA in obese patients, particularly those who are morbidly obese. 3,4,6 However, no studies have sought to establish the size of this association in clinical practice in the UK. This needs to be addressed as OSA is associated with premature death and reduced healthrelated quality of life; for example, an Israeli study 7 found that the combination of obesity and severe OSA conferred a 44% higher risk of death than OSA alone (p=0.03).…”

Section: Introductionmentioning

confidence: 99%

Body mass index and obstructive sleep apnoea in the UK: a cross-sectional study of the over-50s

Wall¹,

Smith

Hubbard

2012

Primary Care Respiratory Journal

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“…In adults, large neck circumference (NC) identifies individuals at increased risk for OSA. [21][22][23][24][25] NC has not been evaluated as a screening tool for OSA in children.…”

Section: Introductionmentioning

confidence: 99%

Inter‐ and intra‐rater reliability of neck circumference measurements in children

LaBerge

Vaccani

Gow

et al. 2008

Pediatric Pulmonology

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Summary. Rationale: Increased neck circumference is a risk factor for obstructive sleep apnea in adults. With rising obesity prevalence in children, it may be an important identifier of obstructive sleep apnea in children. The reliability of measuring neck circumference in children has not been systematically evaluated. Objective: To determine the inter-and intra-rater reliability of neck circumference measurements in children aged 2-16 years. Methods: Children aged 2-16 years with limb fractures were recruited. Neck circumference was measured by three investigators each using two separate unmarked paper tapes in the 2-5 year age group (N ¼ 43), and three separate tapes in the 6-10 and 11-16 year age groups (N ¼ 18 and 40). Results: Neck circumference measurements showed excellent inter-rater reliability for children 6-10 and 11-16 years (ICC ¼ 0.952 and 0.989). Substantial variation was observed for the 2-5 year age group (ICC ¼ 0.701). Good intra-rater reliability was demonstrated for the three groups (ICC range: 0.776, 0.950). Repeatability coefficients were 2.5-3.4 cm in the youngest age group and were 1.2-1.4 cm in the 6-16 year age group. Conclusion: In children 6-16 years old, neck circumference shows very good inter and good intra-rater reliability. Multiple measurements are not required for precision and reliability.

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A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study

Cited by 62 publications

References 20 publications

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

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

Body mass index and obstructive sleep apnoea in the UK: a cross-sectional study of the over-50s

Inter‐ and intra‐rater reliability of neck circumference measurements in children

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