Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates.
OBJECTIVE
There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities.


METHODS
Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire.


METHODS
Clinical referral setting.


METHODS
Children, ages 5 to 9.9 y with OSAS.


RESULTS
Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ≤ AHI < 30 or 1 ≤ obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant.


CONCLUSIONS
Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity.


BACKGROUND
Clinicaltrials.gov (#NCT00560859).
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Tanya G
TG
Weinstock
Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH.
Carol L
CL
Rosen
Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Carole L
CL
Marcus
Department of Otolaryngology, University of Michigan Medical Center, Ann Arbor, MI.
Susan
S
Garetz
University of Texas Southwestern Medical Center, Dallas, TX.
Ron B
RB
Mitchell
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Raouf
R
Amin
Department of Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University, St Louis, MO.
Shalini
S
Paruthi
Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Eliot
E
Katz
Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
Raanan
R
Arens
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Jia
J
Weng
Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH.
Kristie
K
Ross
Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI.
Ronald D
RD
Chervin
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
Susan
S
Ellenberg
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Rui
R
Wang
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Susan
S
Redline
D000233:Adenoidectomy; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity; D017286:Polysomnography; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D012923:Social Class; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D014068:Tonsillectomy
D014028:Tobacco Smoke Pollution
Adenotonsillectomy; apnea hypopnea index; disparities; obstructive sleep apnea syndrome; polysomnography; tobacco