title: Neck Circumference-Height Ratio as a Predictor of Sleep Related Breathing Disorder in Children and Adults.
abstract: OBJECTIVE
  While neck circumference (NC) is a useful predictor of obstructive sleep apnea (OSA) in adults, childhood OSA is difficult to predict clinically. We utilized the neck circumference-height ratio (NHR) to normalize NC in growing children. Our study aimed to determine if (1) NC is a reproducible clinical measurement; (2) NHR predicts OSA in children; (3) this metric translates to adults.
  
  
  METHODS
  For this retrospective study, paired NC measurements (from clinic and sleep laboratory) in 100 consecutive adult subjects were used to confirm inter-observer reproducibility. Polysomnographic (PSG) and anthropometric data from children aged 5-18 years presenting consecutively between July 2007 and February 2012 was obtained. Children with genetic syndromes, severe neurological disorders, craniofacial abnormalities, tracheostomy, past adenotonsillectomy, in-hospital PSG or sleep efficiency < 80% were excluded. Data were analyzed using χ(2) test and logistic and linear regression models. These analyses were also applied to 99 adult patients with similar exclusion criteria.
  
  
  RESULTS
  Adult NC measurement had inter-observer correlation of 0.85 (N = 100). Among children, after correcting for BMI-Z scores, NHR conferred additional predictive value, in both logistic regression and linear models, for both apnea-hypopnea index (AHI) > 2 and > 5 (N = 507). In children, for NHR > 0.25, the odds ratio of AHI > 2 was 3.47. In adults, for NHR > 0.25, the odds ratio of AHI > 5 was 18.
  
  
  CONCLUSIONS
  NHR can be included as a simple screening tool for OSA in children and adults, which along with other predictors, may improve the ability of clinicians to triage children and adults at risk for OSA for further evaluation with PSG.
authors.affiliation: Cleveland Clinic Sleep Disorders Center, Cleveland, OH.|Section of Pediatric Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Alice W
authors.initials: AW
authors.lastname: Ho
authors.affiliation: Cleveland Clinic Sleep Disorders Center, Cleveland, OH.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Moul
authors.affiliation: Cleveland Clinic Sleep Disorders Center, Cleveland, OH.|Robert T. Stone Respiratory Center, Akron Children's Hospital, Akron, OH.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Krishna
mesh_terms: D000293:Adolescent; D001827:Body Height; D001837:Body Weights and Measures / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009333:Neck / Q000033:anatomy & histology*; D017286:Polysomnography / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*
keywords: children; neck circumference; obstructive sleep apnea