Ho Alice W, Moul Douglas E, Krishna Jyoti
Cleveland Clinic Sleep Disorders Center, Cleveland, OH.
Section of Pediatric Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
J Clin Sleep Med. 2016 Mar;12(3):311-7. doi: 10.5664/jcsm.5572.
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.
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.
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.
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.
虽然颈围（NC）是成人阻塞性睡眠呼吸暂停（OSA）的一个有用预测指标，但儿童OSA在临床上很难预测。我们使用颈围-身高比（NHR）对成长中儿童的颈围进行标准化。我们的研究旨在确定：（1）颈围是否是一种可重复的临床测量指标；（2）颈围-身高比能否预测儿童的阻塞性睡眠呼吸暂停；（3）该指标是否适用于成人。
在这项回顾性研究中，对100名连续的成年受试者进行了配对颈围测量（来自诊所和睡眠实验室），以确认观察者间的可重复性。获取了2007年7月至2012年2月期间连续就诊的5至18岁儿童的多导睡眠图（PSG）和人体测量数据。排除患有遗传综合征、严重神经疾病、颅面畸形、气管造口术、既往腺样体扁桃体切除术、住院期间进行PSG检查或睡眠效率<80%的儿童。使用χ²检验以及逻辑回归和线性回归模型对数据进行分析。这些分析也应用于99名具有类似排除标准的成年患者。
成人颈围测量的观察者间相关性为0.85（N = 100）。在儿童中，校正体重指数Z评分后，在逻辑回归和线性模型中，颈围-身高比对呼吸暂停低通气指数（AHI）>2和>5均具有额外的预测价值（N = 507）。在儿童中，颈围-身高比>0.25时，AHI>2的比值比为3.47。在成人中，颈围-身高比>0.25时，AHI>5的比值比为18。
颈围-身高比可作为儿童和成人阻塞性睡眠呼吸暂停的一种简单筛查工具，与其他预测指标一起，可能会提高临床医生对有阻塞性睡眠呼吸暂停风险的儿童和成人进行分类以便进一步进行多导睡眠图评估的能力。
