Risk factors of obstructive sleep apnea syndrome in obese early adolescents: a prediction model using scoring system.
OBJECTIVE
to obtain the OSAS prevalence and risk factors of OSAS in obese early adolescents and to create a scoring system based on risk factors for diagnosing OSAS.


METHODS
an observational study in Jakarta, November 2007 until December 2008 on obese adolescents aged 10-12 years with snoring. Subjects underwent clinical examination, lung function test, paranasal sinus X-ray, and polisomnography. Measured outcomes were diagnosis of OSAS; sensitivity, specificity, predictive values, and likelihood ratios of a scoring system based on risk factors.


RESULTS
the prevalence of OSAS in obese early adolescents is 38.2% using AHI cut-off point of ≥3 on PSG. Tonsillar hypertrophy, adenoid hypertrophy, and neck circumference were the main risk factors. Scoring system was designed based on these results: OS= T + A + NC; OS= OSAS score; T= tonsil hypertrophy (≥T3 scored 1, <T3 scored 0); A = adenoid hypertrophy (adenoid and nasopharynx ratio of ≥0.8 scored 1.5, <0.8 scored 0); NC = neck circumference (≥34 cm scored 1; <34 cm scored 0). Children were most likely to have OSAS if they had a total score of 3.5. This scoring system has a sensitivity of 62% (95%CI 47 to 77%), specificity 100% (95%CI 100 to 100%), positive predictive value 100% (95%CI 100 to 100%), negative predictive value 81% (95%CI 73 to 89%), unlimited LR(+), LR(-) of 0.38 (CI 95% 0.6 to 0.56).


CONCLUSIONS
a scoring system based on tonsillar hypertrophy, adenoid hypertrophy, and neck circumference has sensitivity and specificity of 62% and 100% in diagnosing OSAS.
Supriyatno
Bambang
B
Department of Child Health, Faculty of Medicine University of Indonesia - dr. Cipto Mangunkusumo Hospital, Jl. Salemba 6, Jakarta Pusat 10430, Indonesia. bangsupri@yahoo.com
Said
Mardjanis
M
Hermani
Bambang
B
Sjarir
Damayanti R
DR
Sastroasmoro
Sudigdo
S
D000234:Adenoids / Q000473:pathology; D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D014066:Palatine Tonsil / Q000473:pathology; D017286:Polysomnography; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology