Johnson Courtney, Leavitt Taylor, Daram Shiva P, Johnson Romaine F, Mitchell Ron B
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Texas, Medical Branch, Galveston, Texas, USA.
Otolaryngol Head Neck Surg. 2022 Sep;167(3):566-572. doi: 10.1177/01945998211058722. Epub 2021 Nov 16.
To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA.
Case-control study.
University of Texas Southwestern Medical Center and Children's Medical Center of Dallas.
Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at < .05.
An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; = .02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; = .01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; = .01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA.
Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies.
确定体重不足儿童阻塞性睡眠呼吸暂停（OSA）的预测因素，并描述不同种族体重不足的OSA儿童的人口统计学、临床和多导睡眠图特征。
病例对照研究。
德克萨斯大学西南医学中心和达拉斯儿童医学中心。
纳入2014年1月至2020年12月间因疑似OSA接受多导睡眠图检查的2至18岁体重不足儿童。根据疾病控制与预防中心指南，体重不足定义为体重指数低于第5百分位数。呼吸暂停低通气指数<1.0的儿童作为对照组。采用单因素和多因素逻辑回归分析确定OSA的预测因素。显著性设定为<0.05。
共有124名儿童符合纳入标准：平均年龄6.4岁；50%为女性；44%为西班牙裔，31%为非裔美国人，18%为白种人。共有83名儿童患有OSA（呼吸暂停低通气指数≥1.0）。身高与OSA呈负相关（比值比，0.94；95%可信区间，0.88 - 0.99；P = 0.02），而过敏性鼻炎（比值比，2.97；95%可信区间，1.24 - 7.08；P = 0.01）和扁桃体肥大（比值比，3.38；95%可信区间，1.42 - 8.02；P = 0.01）是OSA存在的预测因素。没有人口统计学或临床特征是重度OSA的预测因素。
与无OSA的体重不足儿童相比，患有OSA的体重不足儿童更有可能身高降低、扁桃体肥大和患有过敏性鼻炎。体重不足儿童中没有重度OSA的预测因素。我们建议对有症状的扁桃体肿大的体重不足儿童，尤其是有过敏史的儿童，进行多导睡眠图检查以诊断OSA。
