title: The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) study randomized clinical trial.
abstract: OBJECTIVE
  It is important to distinguish children with different levels of severity of obstructive sleep apnea syndrome (OSAS) preoperatively using clinical parameters. This can identify children who most need polysomnography (PSG) prior to adenotonsillectomy (AT).
  
  
  OBJECTIVE
  To assess whether a combination of factors, including demographics, physical examination findings, and caregiver reports from questionnaires, can predict different levels of OSAS severity in children.
  
  
  METHODS
  Baseline data from 453 children from the Childhood Adenotonsillectomy (CHAT) study were analyzed. Children 5.0 to 9.9 years of age with PSG-diagnosed OSAS, who were considered candidates for AT, were included.
  
  
  METHODS
  Polysomnography for diagnosis of OSAS.
  
  
  METHODS
  Linear or logistic regression models were fitted to identify which demographic, clinical, and caregiver reports were significantly associated with the apnea hypopnea index (AHI) and oxygen desaturation index (ODI).
  
  
  RESULTS
  Race (African American), obesity (body mass index z score > 2), and the Pediatric Sleep Questionnaire (PSQ) total score were associated with higher levels of AHI and ODI (P = .05). A multivariable model that included the most significant variables explained less than 3% of the variance in OSAS severity as measured by PSG outcomes. Tonsillar size and Friedman palate position were not associated with increased AHI or ODI. Models that tested for potential effect modification by race or obesity showed no evidence of interactions with any clinical measure, AHI, or ODI (P > .20 for all comparisons).
  
  
  CONCLUSIONS
  This study of more than 450 children with OSAS identifies a number of clinical parameters that are associated with OSAS severity. However, information on demographics, physical findings, and questionnaire responses does not robustly discriminate different levels of OSAS severity.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00560859.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern and Children's Medical Center, Dallas2Department of Pediatrics, University of Texas Southwestern and Children's Medical Center, Dallas.
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sleep Disorders Center, University of Michigan, Ann Arbor.
authors.forename: Suzan
authors.initials: S
authors.lastname: Garetz
authors.affiliation: Department of Statistics, North Carolina State University, Raleigh.
authors.forename: Reneé H
authors.initials: RH
authors.lastname: Moore
authors.affiliation: Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia.
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.affiliation: Department of Pediatrics, Montefiore Medical Center, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
authors.affiliation: Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, Missouri.
authors.forename: Shalini
authors.initials: S
authors.lastname: Paruthi
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Raouf
authors.initials: R
authors.lastname: Amin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Lisa
authors.initials: L
authors.lastname: Elden
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Ellenberg
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts15Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D017286:Polysomnography; D044469:Racial Groups; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery; D011795:Surveys and Questionnaires