Neck circumference percentile: A screening tool for pediatric obstructive sleep apnea

Pediatr Pulmonol. 2015 Feb;50(2):196-201. doi: 10.1002/ppul.23003. Epub 2014 Feb 21.


Rationale: Large neck circumference (NC) is associated with obstructive sleep apnea (OSA) in adults, especially males. Since NC changes with age and sex, a lack of reference ranges makes neck size difficult to assess as a screening tool in children.

Methods: Using a population-based dataset of 1,913 children, we developed reference ranges for NC by age and sex for children aged 6-17 years. In this study, we collected NC data on 245 children aged 6-17 years presenting to the Children's Hospital of Eastern Ontario for polysomnography. The association between NC>the 95th percentile and OSA (total apnea-hypopnea-index>5 events/hr and/or obstructive-apnea-index ≥ 1 event/hr) was explored. Thresholds of BMI percentile and waist circumference were also examined.

Results: Individuals with NC>95th percentile for age and sex had increased risk of OSA (relative risk 1.7 [95% CI 1.0-3.0], P=0.04), compared to those with NC ≤ 95th percentile. BMI ≥ 95th percentile gave similar results (relative risk 1.8 [95% CI 1.1-2.9], P=0.02). When examined by sex, the association was significant in males ≥ 12 years (relative risk 3.3 [95% CI 1.0-10.4], P=0.04), but not females (P=0.63). Neither BMI ≥ 95th percentile nor waist circumference>95th percentile was significant.

Conclusions: Children and youth with NC>95th percentile for age and sex have significantly increased risk of OSA. This effect is significant in males ≥ 12 years, whereas BMI is not. NC percentile may be an additional screening tool for OSA in children and youth.

Keywords: neck circumference; obstructive sleep apnea; pediatric; percentiles; predictor.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Body Mass Index
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Neck / anatomy & histology*
  • Prospective Studies
  • Reference Values
  • Risk Assessment
  • Sex Factors
  • Sleep Apnea, Obstructive / diagnosis*
  • Waist Circumference