1. Effect of body weight on upper airway findings and treatment outcome in children with obstructive sleep apnea
- Author
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E. Van de Perck, Olivier M. Vanderveken, Vera Saldien, An Boudewyns, Stijn Verhulst, and K. Van Hoorenbeeck
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Polysomnography ,Overweight ,Adenoidectomy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Continuous positive airway pressure ,Child ,Retrospective Studies ,Sleep Apnea, Obstructive ,medicine.diagnostic_test ,business.industry ,Body Weight ,Endoscopy ,General Medicine ,Odds ratio ,medicine.disease ,respiratory tract diseases ,Tonsillectomy ,Obstructive sleep apnea ,Treatment Outcome ,030228 respiratory system ,Child, Preschool ,Human medicine ,medicine.symptom ,business ,Airway ,Body mass index ,030217 neurology & neurosurgery - Abstract
Objective/background: Surgical interventions for obstructive sleep apnea (OSA) are less effective in obese than in normal-weight children. However, the mechanisms that underpin this relationship are not fully understood. Therefore, this study aimed to explore how body weight influences upper airway collapse and treatment outcome in children with OSA. Methods: We conducted a retrospective analysis of prospectively collected data on polysomnography, drug-induced sleep endoscopy (DISE), and treatment outcome in otherwise healthy children with OSA. Associations between body mass index (BMI) z-score and upper airway collapse during DISE were assessed using logistic regression modelling. Treatment success was defined as obstructive apnea-hypopnea index (oAHI) < 5 events/hour and cure as oAHI < 2 events/hour with obstructive apnea index < 1 event/hour. Results: A total of 139 children were included [median (Q1-Q3); age 4.5 (3.1-8.4) years; BMI z-score 0.3 (-0.8 to 1.4); oAHI 10.8 (6.8-18.0) events/hour]. Twenty-five of them were overweight and 21 were obese. After adjusting for age and history of upper airway surgery, BMI z-score was significantly correlated with circumferential upper airway collapse during DISE (odds ratio 1.67; 95% confidence interval 1.12-2.65; P = 0.011). Outcome of DISE-directed treatment was similar in normal-weight (success: 91.4%; cure: 78.5%), overweight (success: 88.0%; cure: 80.0%), and obese (success: 90.5%; cure: 76.5%) children. Children with circumferential collapse responded better to continuous positive airway pressure than to (adeno)tonsillectomy. Conclusion: Increasing body weight is associated with circumferential upper airway collapse during DISE and, accordingly, may require treatment strategies other than (adeno)tonsillectomy. (C) 2021 Elsevier B.V. All rights reserved.
- Published
- 2021
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