The obstructive sleep apnoea syndrome in adolescents

Marcus, Carole L.; Keenan, Brendan T.; Huang, Jingtao; Yuan, Haibo; Pinto, Swaroop; Bradford, Ruth; Kim, Christopher; Bagchi, Sheila; Comyn, François-Louis; Wang, Stephen; Tapia, Ignacio E.; Maislin, Greg; Cielo, Christopher M.; Traylor, Joel; Torigian, Drew A.; Schwab, Richard J.

doi:10.1136/thoraxjnl-2016-208660

Cited by 24 publications

(12 citation statements)

References 29 publications

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“…This is in keeping with literature demonstrating that obesity-related OSA is multifactorial—that is, related to lymphoid hyperplasia, increased fat deposition in the upper airway, and neuromotor factors predisposing to upper airway collapsibility. 24,25 Specifically, in a recent static magnetic resonance imaging study, Schwab and colleagues demonstrated the importance of adenoid and tonsillar hypertrophy in the pathogenesis of OSA in obese adolescents. 25 Our study is in agreement with these results and provides clinicians with a potential easy-to-use predictive tool for screening the obese pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth

Narang

Al-Saleh

Amin

et al. 2017

Otolaryngol.--head neck surg.

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Objectives To determine whether neck:height ratio combined with adenoid and tonsillar size is a good predictive tool for obstructive sleep apnea in obese youth. Study Design Cross-sectional study. Setting Sleep clinics at the Hospital for Sick Children, Toronto, Canada. Subjects and Methods Consented obese individuals aged 8 to 18 years were recruited between 2013 and 2015. Anthropometric measures were obtained by a trained research coordinator in a standardized manner. Otolaryngologists evaluated adenoid and tonsil sizes. Obstructive sleep apnea was diagnosed with an overnight polysomnogram as an obstructive apnea-hypopnea index ≥2. Multivariable logistic regressions investigated the relationship between potential predictors and obstructive sleep apnea. The C-statistic measured the predictive ability. Results Of the 53 subjects (median age, 13 years; 55% males), 28 (53%) were diagnosed with obstructive sleep apnea, with a median index of 10.6 per hour. In a logistic regression controlling for adenoid size, enlarged tonsils were significantly associated with the presence of obstructive sleep apnea ( P < .01). Adding neck:height ratio into the model improved the model predictive ability (C-index increased from 0.73 to 0.84). Controlling for tonsil and adenoid sizes, an increase in neck:height ratio was significantly associated with the presence of obstructive sleep apnea ( P = .01). Conclusion Our study suggests that neck:height ratio combined with tonsillar hypertrophy may have a strong predictive ability for obstructive sleep apnea and may be useful in an ambulatory setting to screen obese youth at high risk. These findings should be confirmed in a larger study.

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Section: Discussionmentioning

confidence: 99%

Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth

Narang

Al-Saleh

Amin

et al. 2017

Otolaryngol.--head neck surg.

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“…It is becoming increasingly recognized that in adolescents and adults, the pathophysiology of SDB is a complex interaction between an anatomically compromised airway and other non-anatomical factors or traits. 15,16 A number of non-anatomical traits have been identified in the adult literature, including neuromuscular activation of the pharyngeal dilators, the respiratory arousal threshold and ventilatory control stability, as contributors to the development of OSA. 8 Despite the increased understanding of these non-anatomical traits, characterising these traits in individual patients has proved difficult as they require specialised, invasive techniques.…”

Section: Introductionmentioning

confidence: 99%

Role of ventilatory control instability in children with sleep‐disordered breathing

et al. 2020

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Background and objective: The contribution of nonanatomical factors, such as ventilatory control instability (i.e. LG), to the pathogenesis of obstructive SDB in children is unclear. Therefore, we aimed to identify the relationship between LG and severity of SDB, demographic, anthropometric and anatomical characteristics in a clinically representative cohort of children. Methods: Children (aged 3-18 years) with various severities of SDB (n = 110) and non-snoring controls (n = 36) were studied. Children were grouped according to their OAHI. Anthropometric and upper airway anatomical characteristics were measured. Spontaneous sighs were identified on polysomnography and LG, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern. Results: There was no difference in LG between controls and any of the SDB severity groups. However, LG was significantly lower in children with larger tonsils (tonsil grade 4) compared with children with smaller tonsils (tonsil grade 1) (median LG (range): 0.25 (0.20-0.42) vs 0.32 (0.25-0.44); P = 0.009) and in children with a modified Mallampati score of class III/IV compared with class I (0.28 (0.24-0.33) vs 0.37 (0.27-0.44); P = 0.009). Conclusion: A direct relationship was not found between the severity of paediatric SDB and LG. However, an altered ventilatory control sensitivity may contribute to SDB in a subgroup of children depending on their degree of anatomical compromise of the airway.

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“…It has been shown that children and adolescents, with or without obesity, have less upper airway collapsibility compared to adult population. [49][50][51][52] This could explain that OSA is seen more commonly Adult patients herein had lower quality of life than narcoleptic children. As previously reported, narcoleptic patients experience difficulties in social relationships, whether in childhood or adulthood.…”

Section: Discussionmentioning

confidence: 95%

“…Although less obese, adult patients had more OSA than children. It has been shown that children and adolescents, with or without obesity, have less upper airway collapsibility compared to adult population 49‐52 . This could explain that OSA is seen more commonly among older people for the same degree of obesity.…”

Section: Discussionmentioning

confidence: 99%

Narcolepsy with cataplexy: Does age at diagnosis change the clinical picture?

et al. 2020

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Objective To compare symptoms and sleep characteristics in patients diagnosed with narcolepsy‐cataplexy (NC) before and after the age of 18 years. Methods De novo patients with NC diagnosis completed a standardized questionnaire and interview, followed by a sleep study. The clinical and sleep measures were compared between patients diagnosed before (46 children, median age: 12 year old) and after (46 adults, median age: 28.5 year old) 18 years of age. Results The frequency of obesity (54% vs 17%), night eating (29% vs 7%), parasomnia (89% vs 43%), sleep talking (80% vs 34%), and sleep drunkenness (69% vs 24%) were higher in children than in adults, the frequency of sleep paralysis was lower (20% vs 55%) but the frequency of cataplexy and the severity of sleepiness were not different. Children scored higher than adults at the attention‐deficit/hyperactivity disorder (ADHD) scale. Depressive feelings affected not differently children (24%) and adults (32%). However, adults had lower quality of life than children. There was no difference between groups for insomnia and fatigue scores. Quality of life was essentially impacted by depressive feelings in both children and adults. Obstructive apnea‐hypopnea index (OAHI) was lower in children with higher mean and minimal oxygen saturation than in adults. No between‐group differences were found at the multiple sleep latency test. The body mass index (z‐score) was correlated with OAHI (r = .32). Conclusion At time of NC diagnosis, children have more frequent obesity, night eating, parasomnia, sleep talking, drunkenness, and ADHD symptoms than adults, even if sleepiness and cataplexy do not differ. These differences should be considered to ensure a prompt diagnosis.

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The obstructive sleep apnoea syndrome in adolescents

Abstract: OSAS in adolescents is mediated by a combination of anatomic (ATV, NPAV) and neuromotor factors (activated Pcrit). This may have important implications for the management of OSAS in adolescents.

Cited by 24 publications

References 29 publications

Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth

Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth

Role of ventilatory control instability in children with sleep‐disordered breathing

Narcolepsy with cataplexy: Does age at diagnosis change the clinical picture?

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