Use of tonsil size in the evaluation of obstructive sleep apnoea

Aims: (1) To determine the extent to which tonsil size contributes to the severity of obstructive sleep apnoea (OSA) in children; and (2) to assess the use of tonsillar-pharyngeal (TP) ratio in differentiating patients with different severity of OSA. Methods: Lateral neck radiograph was performed on...

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Bibliographic Details
Published in:Archives of disease in childhood 2002-08, Vol.87 (2), p.156-159
Main Authors: Li, A M, Wong, E, Kew, J, Hui, S, Fok, T F
Format: Article
Language:English
Subjects:
Age
AHI
Airway management
apnoea–hyperpnoea index
Biological and medical sciences
Causes of
Child
Child Health Series
Child, Preschool
Childhood sleep disorders
Children & youth
Feasibility Studies
Female
Humans
Hyperplasia - complications
Hyperplasia - diagnostic imaging
Infant
Inspection
Investigative techniques, diagnostic techniques (general aspects)
lateral neck radiograph
Male
Measurement Techniques
Medical Evaluation
Medical sciences
Methods
Non tumoral diseases
obstructive sleep apnoea
obstructive sleep apnoea syndrome
OSA
OSAS
Otorhinolaryngology (head neck, general aspects and miscellaneous)
Otorhinolaryngology. Stomatology
Otorhinolaryngology. Stomatology. Orbit
Palatine Tonsil - diagnostic imaging
Palatine Tonsil - pathology
Patients
Pharynx - pathology
Physical Examinations
Physiological aspects
Polysomnography
PSG
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Radiography
receiver operating charactristic
ROC
ROC Curve
Sensitivity and Specificity
Sleep
Sleep apnea
Sleep apnea syndromes
Sleep Apnea, Obstructive - etiology
Sleep Apnea, Obstructive - pathology
Sleep disorders in children
Statistical Analysis
Studies
tonsillar hypertrophy
tonsillar-pharyngeal
Tonsils
Tropical medicine
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Description
Summary:Aims: (1) To determine the extent to which tonsil size contributes to the severity of obstructive sleep apnoea (OSA) in children; and (2) to assess the use of tonsillar-pharyngeal (TP) ratio in differentiating patients with different severity of OSA. Methods: Lateral neck radiograph was performed on 35 children referred consecutively to a university paediatric chest clinic for suspected OSA secondary to tonsillar hypertrophy. The tonsil size was determined by measuring the TP ratio on the radiographs. The severity of OSA was assessed by overnight polysomnography. Results: A total of 24 boys and 11 girls (median age 6.2 years) were studied. All presented with symptoms of OSA, and tonsillar hypertrophy was detected on clinical examination. The median apnoea–hypopnoea index (AHI) was 16.93 (interquartile range: 8.41 to 28.29). The median TP ratio was 0.76 (interquartile range: 0.65 to 0.80). AHI was positively correlated with the TP ratio. The clinical tonsil size did not correlate with the AHI or the TP ratio. Using a TP ratio of 0.479, the sensitivity and specificity in predicting cases with moderate/severe OSA (AHI >10) were 95.8% and 81.8% respectively, while the positive and negative predictive values were 92.0% and 90.0% respectively. Conclusions: Results show that in a population of children with OSA, tonsillar hypertrophy as assessed by lateral neck radiograph correlates positively with the severity of obstructive sleep apnoea. The TP ratio has high sensitivity and specificity in predicting those with moderate/severe disease and this feature may be used as a clinical screening method in prioritising patients with OSA for further assessment.
ISSN:0003-9888
1468-2044
DOI:10.1136/adc.87.2.156