title: Deep cervical lymph node hypertrophy: a new paradigm in the understanding of pediatric obstructive sleep apnea.
abstract: OBJECTIVE
  To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy.
  
  
  METHODS
  Prospective case control study.
  
  
  METHODS
  A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data.
  
  
  RESULTS
  Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m(2)). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2 , and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm(3), P < 0.001), upper jugular region (22202 vs. 16819 mm(3), P < 0.005), and adenotonsillar region (18994 vs. 12675 mm(3), P < 0.0001).
  
  
  CONCLUSIONS
  Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital-University of Washington School of Medicine, Seattle, Washington 98105, USA. sanjay.parikh@seattlechildrens.org
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
authors.forename: Babak
authors.initials: B
authors.lastname: Sadoughi
authors.forename: Sanghun
authors.initials: S
authors.lastname: Sin
authors.forename: Seth
authors.initials: S
authors.lastname: Willen
authors.forename: Kiran
authors.initials: K
authors.lastname: Nandalike
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
mesh_terms: D000234:Adenoids / Q000473:pathology*; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology*; D017286:Polysomnography; D011446:Prospective Studies; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000473:pathology*
keywords: MRI; apnea; children; etiology; sleep