Abstract
Background. Obese adolescents with Obstructive Sleep Apnea (OSA) have a unique pathophysiology that combines adenotonsillar hypertrophy and increased visceral fat distribution. We hypothesized that in this population waist circumference (WC), as a clinical marker of abdominal fat distribution, correlates with the likelihood of response to AT. Methods. We conducted a retrospective cohort study of obese adolescents (BMI ≥ 97th percentile) that underwent AT for therapy of severe OSA (n = 21). We contrasted WC and covariates in a group of subjects that had complete resolution of severe OSA after AT (n = 7) with those obtained in subjects with residual OSA after AT (n = 14). Multivariate linear and logistic models were built to control possible confounders. Results. WC correlated negatively with a positive AT response in young adolescents and the percentage of improvement in obstructive apnea-hypopnea index (OAHI) after AT (P ≤ 0.01). Extended multivariate analysis demonstrated that the link between WC and AT response was independent of demographic variables, OSA severity, clinical upper airway assessment, obesity severity (BMI), and neck circumference (NC). Conclusion. The results suggest that in obese adolescents, abdominal fat distribution determined by WC may be a useful clinical predictor for residual OSA after AT.
Highlights
Obstructive Sleep Apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, resulting in oxygen desaturation and sleep disruption [1]
Our study population included young adolescents (10–16 years old) selected from our database of all children that underwent routine overnight polysomnography (PSG) at the Penn State Sleep Research and Treatment Center between September 2009 and October 2011. Patients of both genders and all ethnicities were eligible for the study if: (1) they were obese (BMI ≥ 97th percentile for age and sex according to 2000 CDC growth charts for the United States), (2) had diagnosis of severe OSA defined as apnea–hypopnea index (OAHI) ≥10 events per hour on their initial PSG, (3) underwent AT for therapy of OSA, (4) had undergone a PSG within 6 months after AT, and (5) had documented clinical assessment of upper airway and fat distribution prior to AT
We aimed to identify the clinical features that may predict which obese adolescents with severe OSA may have a beneficial response to AT
Summary
Obstructive Sleep Apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, resulting in oxygen desaturation and sleep disruption [1]. Adenotonsillar enlargement is the most commonly recognized anatomic cause for pediatric OSA [1], and obesity is the major risk factor during adulthood [2, 3]. Obesity increases the risk of residual OSA after AT in the pediatric population [8], the obesity features associated with decreased response to AT in children and adolescents are largely unknown. Obese adolescents with Obstructive Sleep Apnea (OSA) have a unique pathophysiology that combines adenotonsillar hypertrophy and increased visceral fat distribution. Extended multivariate analysis demonstrated that the link between WC and AT response was independent of demographic variables, OSA severity, clinical upper airway assessment, obesity severity (BMI), and neck circumference (NC). The results suggest that in obese adolescents, abdominal fat distribution determined by WC may be a useful clinical predictor for residual OSA after AT
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