title: Usefulness of adenotonsillar size for prediction of severity of obstructive sleep apnea and flow limitation.
abstract: OBJECTIVE
  Adenotonsillar hypertrophy is considered the most common cause of pediatric obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the relationships between tonsil/adenoid size, parameters of polysomnography, and subjective sleep symptoms.
  
  
  METHODS
  Case-control studies.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  A 4-point tonsil grading method and adenoid-nasopharynx (AN) ratio were used to categorize tonsil and adenoid size, respectively. Sleep questionnaires (Korean version of the Obstructive Sleep Apnea-18 [KOSA-18]) and full-attended polysomnography were performed.
  
  
  RESULTS
  The subjects (n = 70) were divided into a control group (n = 31, apnea-hypopnea index [AHI] <1) and an OSAS group (n = 39, AHI ≥ 1), which was subdivided into mild and moderate to severe groups. Tonsil/adenoid size showed a statistically significant difference between control and OSAS groups, but these differences had no clinical significance. In addition, tonsil/adenoid size did not differ significantly among 2 OSAS severity subgroups. Only adenoid size in the total and OSAS groups was related to quality of life (QOL) by the KOSA-18. The AN ratio was related to lowest oxygen saturation only in the OSAS group, especially in the moderate to severe OSAS group, but tonsil size was related to flow limitation in total and supine positions in the control group. In the control group, flow limitation was not associated with QOL.
  
  
  CONCLUSIONS
  Tonsil/adenoid size did not predict the severity of AHI. Nevertheless, adenoid size might be related to lowest oxygen saturation, which is thought to be related to subjective symptoms. Although flow limitation was related to tonsil size but not to QOL in the control group, further research will be needed to understand the importance of flow limitation and upper airway resistance syndrome in the pediatric population.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, St Mary's Hospital, Bucheon, South Korea.
authors.forename: Se-Hwan
authors.initials: SH
authors.lastname: Hwang
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
authors.forename: Chan-Soon
authors.initials: CS
authors.lastname: Park
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Seung-Chul
authors.initials: SC
authors.lastname: Hong
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging* / Q000473:pathology; D002508:Cephalometry / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000175:diagnosis; D008297:Male; D014066:Palatine Tonsil / Q000000981:diagnostic imaging* / Q000473:pathology; D017286:Polysomnography; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: adenotonsillar hypertrophy; child; obstructive sleep apnea syndrome; polysomnography