title: Association of childhood high body mass index and sleep disordered breathing with perioperative laryngospasm.
abstract: BACKGROUND
  Childhood high body mass index (BMI) and sleep disordered breathing (SDB) are increasingly prevalent and both are associated with perioperative respiratory complications. Laryngospasm is one of the more serious respiratory complications with potentially devastating consequences. It is presently unclear whether high BMI and incident SDB in children significantly amplifies the risks of perioperative laryngospasm. This study examined the hypothesis that compared to controls; children with high BMI and SDB at the time of surgery have higher rates of perioperative laryngospasm.
  
  
  METHODS
  Children (6-18 yr) who underwent elective, non-cardiac operations at a tertiary care center were the subjects of this cross-sectional study. Rates of perioperative laryngospasm were compared between normal controls and children who were overweight/obese and had clinical history of SDB at the time of surgery. Stepwise logistic regression analysis was performed to identify independent predictors of perioperative laryngospasm (dependent variable) using high BMI/SDB as the primary predictor variable.
  
  
  RESULTS
  Among 642 children, those who were overweight/obese and had incident SDB (N = 197) were younger, and had higher indexes of central adiposity. Children with high BMI and SDB had 3.8 times higher unadjusted odds of developing intraoperative laryngospasm (OR = 3.8; 95% CI = 2.1-6.9, p < 0.001). After adjusting for several relevant covariates, the following factors were found to be independent predictors of perioperative laryngospasm: high BMI + SDB, male sex and increasing neck circumference.
  
  
  CONCLUSIONS
  High BMI and incident SDB in children is associated with increased rates of perioperative laryngospasm. The mechanism(s) underlying this propensity to laryngospasm deserve further elucidation.
authors.affiliation: Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA. Electronic address: onafiu@med.umich.edu.
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: Yosha
authors.initials: Y
authors.lastname: Prasad
authors.forename: Wilson T
authors.initials: WT
authors.lastname: Chimbira
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D015992:Body Mass Index; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007826:Laryngismus / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D017286:Polysomnography / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D062606:Tertiary Care Centers
keywords: Childhood obesity; General anesthesia; Laryngospasm; Risk factors; Sleep disordered breathing