Publication related to RSI or an RSI staff member
Does neck-to-waist ratio predict obstructive sleep apnea in children?
OBJECTIVES: Central adiposity and large neck circumference are associated with obstructive sleep apnea (OSA) in adults but have not been evaluated in children as predictors of OSA. Study objectives were to determine whether (1) anthropometric measures including neck-to-waist ratio are associated with OSA in older children; (2) body fat distribution, measured by neck-to-waist ratio, is predictive of OSA in overweight/obese children. METHODS: Cross-sectional study involving children 7-18 years scheduled to undergo polysomnography at a tertiary care children’s hospital. OSA was defined as total apnea-hypopnea index > 5 events/h and/or obstructive apnea index > 1 event/h. Recursive partitioning was used to select candidate predictors of OSA from: age, sex, height and weight percentile, body mass index (BMI) z-score, neck-to-waist ratio, tonsil size, and Mallampati score. These were then evaluated using log binomial models and receiver operator characteristic analysis. RESULTS: Two hundred twenty-two participants were included; 133 (60%) were overweight/obese, 121 (55%) male,47 (21%) had OSA. Neck-to-waist ratio (relative risk [RR] 1.97 per 0.1 units, 95% CI 1.48 to 2.84) and BMI z-score (RR 1.63 per unit, 95% CI 1.30 to 2.05) were identified as independent predictors of OSA. Considering only overweight/obese children, neck-to-waist ratio (RR 2.16 per 0.1 units, 95% CI 1.79 to 2.59) and BMI z-score (RR 2.02 per unit, 95% CI 1.25 to 3.26) also independently predicted OSA. However, in children not overweight/obese, these variables were not predictive of OSA. CONCLUSIONS: Neck-to-waist ratio, an index of body fat distribution, predicts OSA in older children and youth, especially in those who were overweight/obese.
Authors
- Katz, Sherri Lynne, Katz SL, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Respirology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
- Vaccani, Jean-Philippe, Vaccani JP, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Otolaryngology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
- Barrowman, Nick, Barrowman N, Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
- Momoli, Franco, Momoli F, Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology, Ottawa Hospital Research Institute; Department of Epidemiology and Community Medicine, University of Ottawa.
- Bradbury, Carol L, Bradbury CL, Department of Anesthesia, University Hospital, Coventry, UK.
- Murto, Kimmo, Murto K, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Anesthesiology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
OBJECTIVES: Central adiposity and large neck circumference are associated with obstructive sleep apnea (OSA) in adults but have not been evaluated in children as predictors of OSA. Study objectives were to determine whether (1) anthropometric measures including neck-to-waist ratio are associated with OSA in older children; (2) body fat distribution, measured by neck-to-waist ratio, is predictive of OSA in overweight/obese children. METHODS: Cross-sectional study involving children 7-18 years scheduled to undergo polysomnography at a tertiary care children's hospital. OSA was defined as total apnea-hypopnea index > 5 events/h and/or obstructive apnea index > 1 event/h. Recursive partitioning was used to select candidate predictors of OSA from: age, sex, height and weight percentile, body mass index (BMI) z-score, neck-to-waist ratio, tonsil size, and Mallampati score. These were then evaluated using log binomial models and receiver operator characteristic analysis. RESULTS: Two hundred twenty-two participants were included; 133 (60%) were overweight/obese, 121 (55%) male,47 (21%) had OSA. Neck-to-waist ratio (relative risk [RR] 1.97 per 0.1 units, 95% CI 1.48 to 2.84) and BMI z-score (RR 1.63 per unit, 95% CI 1.30 to 2.05) were identified as independent predictors of OSA. Considering only overweight/obese children, neck-to-waist ratio (RR 2.16 per 0.1 units, 95% CI 1.79 to 2.59) and BMI z-score (RR 2.02 per unit, 95% CI 1.25 to 3.26) also independently predicted OSA. However, in children not overweight/obese, these variables were not predictive of OSA. CONCLUSIONS: Neck-to-waist ratio, an index of body fat distribution, predicts OSA in older children and youth, especially in those who were overweight/obese.
