Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth

Otolaryngol Head Neck Surg. 2018 Apr;158(4):745-751. doi: 10.1177/0194599817740349. Epub 2017 Nov 7.


Objectives To determine whether neck:height ratio combined with adenoid and tonsillar size is a good predictive tool for obstructive sleep apnea in obese youth. Study Design Cross-sectional study. Setting Sleep clinics at the Hospital for Sick Children, Toronto, Canada. Subjects and Methods Consented obese individuals aged 8 to 18 years were recruited between 2013 and 2015. Anthropometric measures were obtained by a trained research coordinator in a standardized manner. Otolaryngologists evaluated adenoid and tonsil sizes. Obstructive sleep apnea was diagnosed with an overnight polysomnogram as an obstructive apnea-hypopnea index ≥2. Multivariable logistic regressions investigated the relationship between potential predictors and obstructive sleep apnea. The C-statistic measured the predictive ability. Results Of the 53 subjects (median age, 13 years; 55% males), 28 (53%) were diagnosed with obstructive sleep apnea, with a median index of 10.6 per hour. In a logistic regression controlling for adenoid size, enlarged tonsils were significantly associated with the presence of obstructive sleep apnea ( P < .01). Adding neck:height ratio into the model improved the model predictive ability (C-index increased from 0.73 to 0.84). Controlling for tonsil and adenoid sizes, an increase in neck:height ratio was significantly associated with the presence of obstructive sleep apnea ( P = .01). Conclusion Our study suggests that neck:height ratio combined with tonsillar hypertrophy may have a strong predictive ability for obstructive sleep apnea and may be useful in an ambulatory setting to screen obese youth at high risk. These findings should be confirmed in a larger study.

Keywords: obesity; obstructive sleep apnea; pediatrics.

MeSH terms

  • Adenoids / anatomy & histology
  • Adolescent
  • Anthropometry
  • Body Height*
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Neck / anatomy & histology*
  • Obesity / complications*
  • Ontario
  • Palatine Tonsil / anatomy & histology*
  • Polysomnography
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / etiology*