title: Does neck-to-waist ratio predict obstructive sleep apnea in children?
abstract: OBJECTIVE
  Central adiposity and large neck circumference are associated with obstructive sleep apnea (OSA) in adults but have not been evaluated in children as predictors of OSA. Study objectives were to determine whether (1) anthropometric measures including neck-to-waist ratio are associated with OSA in older children; (2) body fat distribution, measured by neck-to-waist ratio, is predictive of OSA in overweight/obese children.
  
  
  METHODS
  Cross-sectional study involving children 7-18 years scheduled to undergo polysomnography at a tertiary care children's hospital. OSA was defined as total apnea-hypopnea index > 5 events/h and/or obstructive apnea index > 1 event/h. Recursive partitioning was used to select candidate predictors of OSA from: age, sex, height and weight percentile, body mass index (BMI) z-score, neck-to-waist ratio, tonsil size, and Mallampati score. These were then evaluated using log binomial models and receiver operator characteristic analysis.
  
  
  RESULTS
  Two hundred twenty-two participants were included; 133 (60%) were overweight/obese, 121 (55%) male,47 (21%) had OSA. Neck-to-waist ratio (relative risk [RR] 1.97 per 0.1 units, 95% CI 1.48 to 2.84) and BMI z-score (RR 1.63 per unit, 95% CI 1.30 to 2.05) were identified as independent predictors of OSA. Considering only overweight/obese children, neck-to-waist ratio (RR 2.16 per 0.1 units, 95% CI 1.79 to 2.59) and BMI z-score (RR 2.02 per unit, 95% CI 1.25 to 3.26) also independently predicted OSA. However, in children not overweight/obese, these variables were not predictive of OSA.
  
  
  CONCLUSIONS
  Neck-to-waist ratio, an index of body fat distribution, predicts OSA in older children and youth, especially in those who were overweight/obese.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Respirology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Sherri Lynne
authors.initials: SL
authors.lastname: Katz
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Otolaryngology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Vaccani
authors.affiliation: Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Barrowman
authors.affiliation: Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology, Ottawa Hospital Research Institute; Department of Epidemiology and Community Medicine, University of Ottawa.
authors.forename: Franco
authors.initials: F
authors.lastname: Momoli
authors.affiliation: Department of Anesthesia, University Hospital, Coventry, UK.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Bradbury
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Anesthesiology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Murto
mesh_terms: D000293:Adolescent; D050218:Body Fat Distribution / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009333:Neck; D050177:Overweight / Q000150:complications*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D055105:Waist Circumference
keywords: body fat distribution; obesity; obstructive sleep apnea; screening; sleep