Predictors of Obstructive Sleep Apnea Severity in Adolescents | Adolescent Medicine | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Navigation Landing]
Original Investigation
May 2017

Predictors of Obstructive Sleep Apnea Severity in Adolescents

Author Affiliations
  • 1University of Texas Southwestern Medical Center, Dallas
  • 2Children’s Health, Children’s Medical Center Dallas, Dallas, Texas
JAMA Otolaryngol Head Neck Surg. 2017;143(5):494-499. doi:10.1001/jamaoto.2016.4130
Key Points

Question  Which demographic and clinical variables are correlated with severe obstructive sleep apnea in adolescents?

Findings  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.

Meaning  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.


Importance  Untreated obstructive sleep apnea has severe health consequences, yet little is known about predictors of sleep apnea severity in the adolescent population.

Objective  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.

Exposures  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.

Results  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.