Obstructive Sleep Apnea in Children Relative Contributions of Body Mass Index and Adenotonsillar Hypertrophy
Obstructive Sleep Apnea in Children Relative Contributions of Body Mass Index and Adenotonsillar Hypertrophy
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DOI：
10.1378/chest.08-2568
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发表时间：
2009-07-01
期刊：
影响因子：
9.6
通讯作者：
Gozal, David
中科院分区：
文献类型：
--
作者：
Dayyat, Ehab;Kheirandish-Gozal, Leila;Gozal, David
背景：肥胖流行导致因习惯性打鼾而转诊的肥胖儿童比例发生显着变化。然而，肥胖对腺样体扁桃体肥大的影响仍不清楚。 方法：在我们的研究中，206 名非肥胖习惯性打鼾且经多导睡眠图诊断患有阻塞性睡眠呼吸暂停 (OSA) 的儿童与 206 名肥胖儿童进行了年龄、性别、种族和阻塞性呼吸暂停低通气指数 (OAHI) 的匹配。获得了扁桃体和腺样体的大小估计值以及 Mallampati 等级评分，并可用于评估儿科 OSA 中解剖因素与肥胖之间的潜在关系。结果：两组的平均 OAHI 约为 10.0 次/小时总睡眠时间。在非肥胖儿童中，腺样体扁桃体大小与 OAHI 之间存在适度关联（r = 0.22；p < 0.001），但在肥胖儿童中则不然。非肥胖儿童的平均 (+/- SEM) 腺样体扁桃体尺寸较大（分别为 3.85 +/- 0.16 vs 3.01 +/- 0.14]）； p < 0.0001)，相反，肥胖儿童的 Mallampati 等级分数显着较高 (p < 0.0001)。结论：与非肥胖儿童相比，肥胖儿童在任何给定的 OAHI 程度下所需的腺样体扁桃体肥大程度可能更小。肥胖儿童的 Mallampati 评分增加表明，软组织变化和上呼吸道潜在的脂肪沉积可能在患有 OSA 的肥胖和非肥胖儿童扁桃体和腺样体大小的整体差异中发挥重要作用。 （胸部 2009 年；136.137-144）
Background: The obesity epidemic has prompted remarkable changes in the proportion of obese children who are referred for habitual snoring. However, the contribution of obesity to adenotonsillar hypertrophy remains undefined.Methods: In our study, 206 nonobese habitually snoring children with polysomnographically diagnosed obstructive sleep apnea (OSA) were matched for age, gender, ethnicity, and obstructive apnea-hypopnea index (OAHI) to 206 obese children. Size estimates of tonsils and adenoids, and Mallampati class scores were obtained, and allowed for the assessment of potential relationships between anatomic factors and obesity in pediatric OSA.Results: The mean OAHI for the two groups was approximately 10.0 episodes/h total sleep time. There,,vas a modest association between adenotonsillar size and OAHI in nonobese children (r = 0.22; p < 0.001) but not in obese children. The mean (+/- SEM) adenotonsillar size was larger in nonobese children (3.85 +/- 0.16 vs 3.01 +/- 0.14, respective]),; p < 0.0001), and conversely Mallampati class scores were significantly, higher in obese children (p < 0.0001).Conclusion: The magnitude of adenotonsillar hypertrophy required for any given magnitude of OAHI is more likely to be smaller in obese children compared to nonobese children. Increased Mallampati scores in obese children suggest that soft-tissue changes and potentially fat deposition in the upper airway may play a significant role in the global differences in tonsillar and adenoidal size among obese and nonobese children with OSA. (CHEST 2009; 136.137-144)