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Baker M, Scott B, Johnson RF, Mitchell RB. Predictors of Obstructive Sleep Apnea Severity in Adolescents. JAMA Otolaryngol Head Neck Surg. 2017;143(5):494–499. doi:10.1001/jamaoto.2016.4130
Which demographic and clinical variables are correlated with severe obstructive sleep apnea in adolescents?
In this retrospective case series of 224 adolescents, male sex, body mass index z-score, and tonsillar hypertrophy were significantly associated with severe sleep apnea as measured by the apnea hypopnea index. Age and ethnicity were not associated with objective sleep dysfunction.
A low threshold for obtaining polysomnography to screen for sleep apnea is warranted in obese, male adolescents with tonsillar hypertrophy and symptoms of sleep-disordered breathing.
Untreated obstructive sleep apnea has severe health consequences, yet little is known about predictors of sleep apnea severity in the adolescent population.
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.
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.
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 common in 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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