Gatt Dvir, Ahmadiankalati Mojtaba, Voutsas Giorge, Katz Sherri, Lu Zihang, Narang Indra
Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Pediatr Pulmonol. 2024 Jan;59(1):81-88. doi: 10.1002/ppul.26712. Epub 2023 Oct 3.
Obstructive sleep apnea (OSA) is a heterogeneous disorder with a prevalence of 25%-60% in children with obesity. There is a lack of diagnostic tools to identify those at high risk for OSA.
Children with obesity, aged 8-19 years old, were enrolled into an ongoing multicenter, prospective cohort study related to OSA. We performed k-means cluster analysis to identify clinical variables which could help identify obesity related OSA.
In this study, 118 participants were included in the analysis; 40.7% were diagnosed with OSA, 46.6% were female and the mean (SD) body mass index (BMI) and age were 39.7 (9.6) Kg/m², and 14.4 (2.6) years, respectively. The mean (SD) obstructive apnea-hypopnea index (OAHI) was 11.0 (21.1) events/h. We identified two distinct clusters based on three clustering variables (age, BMI z-score, and neck-height ratio [NHR]). The prevalence of OSA in clusters 1 and 2, were 22.4% and 58.3% (p = 0.001), respectively. Children in cluster 2, in comparison to cluster 1, had higher BMI z-score (4.7 (1.1) versus 3.2 (0.7), p < 0.001), higher NHR (0.3 (0.02) versus 0.2 (0.01), p < 0.001) and were older (15.0 (2.2) versus 13.7 (2.9) years, p = 0.09), respectively. However, there were no significant differences in sex and OSA symptoms between the clusters. The results from hierarchical clustering were similar to k-means analysis suggesting that the resulting OSA clusters were stable to different analysis approaches.
BMI, NHR, and age are easily obtained in a clinical setting and can be utilized to identify children at high risk for OSA.
阻塞性睡眠呼吸暂停（OSA）是一种异质性疾病，在肥胖儿童中的患病率为25%-60%。目前缺乏用于识别OSA高危人群的诊断工具。
将8-19岁的肥胖儿童纳入一项正在进行的与OSA相关的多中心前瞻性队列研究。我们进行了k均值聚类分析，以确定有助于识别肥胖相关OSA的临床变量。
本研究共纳入118名参与者进行分析；40.7%被诊断为OSA，46.6%为女性，平均（标准差）体重指数（BMI）和年龄分别为39.7（9.6）kg/m²和14.4（2.6）岁。平均（标准差）阻塞性呼吸暂停低通气指数（OAHI）为11.0（21.1）次/小时。我们根据三个聚类变量（年龄、BMI z评分和颈高比[NHR]）确定了两个不同的聚类。聚类1和聚类2中OSA的患病率分别为22.4%和58.3%（p = 0.001）。与聚类1相比，聚类2中的儿童BMI z评分更高（4.7（1.1）对3.2（0.7），p < 0.001），NHR更高（0.3（0.02）对0.2（0.01），p < 0.001），年龄更大（15.0（2.2）对13.7（2.9）岁，p = 0.09）。然而，各聚类之间在性别和OSA症状方面没有显著差异。层次聚类的结果与k均值分析相似，表明所得的OSA聚类对不同的分析方法具有稳定性。
BMI、NHR和年龄在临床环境中易于获取，可用于识别OSA高危儿童。
