Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates

Sleep. 2014 Feb 1;37(2):261-9. doi: 10.5665/sleep.3394.


Study objectives: There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities.

Design: Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire.

Setting: Clinical referral setting.

Participants: Children, ages 5 to 9.9 y with OSAS.

Measurements and results: Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ≤ AHI < 30 or 1 ≤ obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant.

Conclusions: Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity.

Clinical trial registration: (#NCT00560859).

Keywords: Adenotonsillectomy; apnea hypopnea index; disparities; obstructive sleep apnea syndrome; polysomnography; tobacco.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenoidectomy*
  • Body Mass Index
  • Child
  • Child, Preschool
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Obesity
  • Polysomnography
  • Racial Groups / statistics & numerical data*
  • Risk Factors
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / epidemiology*
  • Sleep Apnea, Obstructive / etiology*
  • Sleep Apnea, Obstructive / physiopathology
  • Social Class
  • Surveys and Questionnaires
  • Tobacco Smoke Pollution / statistics & numerical data*
  • Tonsillectomy*


  • Tobacco Smoke Pollution

Associated data