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VOLUME 22 , ISSUE 7 ( July, 2021 ) > List of Articles

ORIGINAL RESEARCH

Tonsil Size and Mallampati Score as Clinical Predictive Factors for Obstructive Sleep Apnea Severity in Children

Maen Zreaqat, Rozita Hassan, AR Samsudin, Yasser Stas, Abdulfatah Hanoun

Keywords : Mallampati score, Obstructive sleep apnea, Tonsil size

Citation Information : Zreaqat M, Hassan R, Samsudin A, Stas Y, Hanoun A. Tonsil Size and Mallampati Score as Clinical Predictive Factors for Obstructive Sleep Apnea Severity in Children. J Contemp Dent Pract 2021; 22 (7):850-853.

DOI: 10.5005/jp-journals-10024-3148

License: CC BY-NC 4.0

Published Online: 28-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: The aim of this study was to determine the clinical utility of body mass index (BMI), tonsil size, and Mallampati scoring in predicting both the presence of and severity of pediatric obstructive sleep apnea (OSA). Materials and methods: This prospective cross-sectional study comprised 78 growing children in the age range of 11–14 years with polysomnography (PSG)-proven OSA and 86 non-OSA corresponding controls. BMI, tonsil size (Friedman grading scale), and Mallampati score were determined for both groups, and related differences were assessed with a t-test, while their independent association with OSA severity was tested with a regression analysis. Statistical significance was set at p < 0.05. Results: Male gender, BMI, tonsil size, and Mallampati score were significantly higher in the OSA group (p < 0.05). A significant correlation was recorded between the Mallampati score and OSA severity (p < 0.01), but not with BMI or tonsil size (p > 0.05). For every 1-point increase in the Mallampati scale, the apnea-hypopnea index (AHI) increased by more than five events per hour in the bivariate analysis and by more than three events per hour in the multivariate analysis. Conclusion: Male gender, increased BMI, high tonsil, and Mallampati scores were clinical indicators of the presence of OSA. However, only Mallampati scale had a significant association with OSA severity. Clinical diagnostic indicators should be established and encouraged especially in community-based studies. Clinical significance: Clinical diagnostic indicators are very useful in examining and screening children who are at risk of developing OSA as PSG is expensive and unsuitable for universal use in the pediatric population.


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  1. Ohida T, Osaki Y, Doi Y, et al. An epidemiologic study of self-reported sleep problems among Japanese adolescents. Sleep 2004;27(5): 978–985. DOI: 10.1093/sleep/27.5.978.
  2. Alfano CA, Zakem AH, Costa NM, et al. Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depress Anxiety 2009;26(6):503–512. DOI: 10.1002/da.20443.
  3. Taras H, Potts-Datema W. Sleep and student performance at school. J Sch Health 2005;75(7):248–254. DOI: 10.1111/j.1746-1561.2005.00033.x.
  4. Ayas NT, Owens RL, Kheirandish-Gozal L. Update in sleep medicine 2014. Am J Respir Crit Care Med 2015;192(4):415–420. DOI: 10.1164/rccm.201503-0647UP.
  5. Jensen ME, Gibson PG, Collins CE, et al. Airway and systemic inflammation in obese children with asthma. Eur Respir J 2013;42(4):1012–1019. DOI: 10.1183/09031936.00124912.
  6. Spruyt K, Molfese DL, Gozal D. Sleep duration, sleep regularity, body weight, and metabolic homeostasis in school-aged children. Pediatrics 2011;127(2):345–352. DOI: 10.1542/peds.2010-0497.
  7. Liistro G, Rombaux P, Belge C, et al. High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J 2003;21(2):248–252. DOI: 10.1183/09031936.03.00292403.
  8. Ikävalko T, Närhi M, Eloranta AM, et al. Predictors of sleep disordered breathing in children: the PANIC study. Eur J Orthod 2018;40(3): 268–272. DOI: 10.1093/ejo/cjx056.
  9. Certal V, Catumbela E, Winck JC, et al. Clinical assessment of pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2012;122(9):2105–2114. DOI: 10.1002/lary.23465.
  10. Kumar DS, Valenzuela D, Kozak FK, et al. The reliability of clinical tonsil size grading in children. JAMA Otolaryngol Head Neck Surg 2014;140(11):1034–1037. DOI: 10.1001/jamaoto.2014.2338.
  11. Kljajić Z, Roje Ž, Bečić K, et al. Formula for the prediction of apnea/hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: is it reliable? Int J Pediatr Otorhinolaryngol 2017;100:168–173. DOI: 10.1016/j.ijporl.2017.06.032.
  12. Kljajic Z, Glumac S, Deutsch JA, et al. Feasibility study of determining a risk assessment model for obstructive sleep apnea in children based on local findings and clinical indicators. Int J Pediatr Otorhinolaryngol 2020;135(6):110081. DOI: 10.1016/j.ijporl.2020.110081.
  13. Berry RB, Brooks R, Gamaldo C, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med 2017;15(5):665–666. DOI: 10.5664/jcsm.6576.
  14. Gill AI, Schaughency E, Galland BC. Prevalence and factors associated with snoring in 3-year-olds: early links with behavioral adjustment. Sleep Med 2012;13(9):1191–1197. DOI: 10.1016/j.sleep.2012.05.007.
  15. Fietze I, Laharnar N, Obst A, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences–Results of SHIP-Trend. J Sleep Res 2019;28(5):e12770. DOI: 10.1111/jsr.12770.
  16. Barewal RM. Obstructive sleep apnea: the role of gender in prevalence, symptoms, and treatment success. Dent Clin North Am 2019;63(2):297–308. DOI: 10.1016/j.cden.2018.11.009.
  17. Hamilton GS, Joosten SA. Obstructive sleep apnoea and obesity. Aust Fam Physician 2017;46(7):460–463. DOI: 10.1016/j.smrv.2012.08.002.
  18. Tuomilehto H, Seppä J, Uusitupa M. Obesity and obstructive sleep apnea–clinical significance of weight loss. Sleep Med Rev 2013;17(5):321–329. DOI: 10.1016/j.smrv.2012.08.002.
  19. Isaiah A, Spanier AJ, Grattan LM, et al. Predictors of behavioral changes after adenotonsillectomy in pediatric obstructive sleep apnea: a secondary analysis of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2020;146(10):1–9. DOI: 10.1001/jamaoto.2020.2432.
  20. Kohler M, Lushington K, Couper R, et al. Obesity and risk of sleep related upper airway obstruction in Caucasian children. J Clin Sleep Med 2008;4(2):129–136. PMC2335392/18468311.
  21. Redline S, Amin R, Beebe D, et al. The childhood adenotonsillectomy trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. Sleep 2011;34(11):1509–1517. DOI: 10.5665/sleep.1388.
  22. Friedman M, Tanyeri H, La Rosa M, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109(12):1901–1907. DOI: 10.1097/00005537-199912000-00002.
  23. Sutherland K, Keenan BT, Bittencourt L, et al. A global comparison of anatomic risk factors and their relationship to obstructive sleep apnea severity in clinical samples. J Clin Sleep Med 2019;15(4):629–639. DOI: 10.5664/jcsm.7730.
  24. Kaditis AG, Lianou L, Hatzinikolaou S, et al. Tonsillar size in 2- to 14-year-old children with and without snoring. Pediatr Pulmonol 2009;44(12):1216–1222. DOI: 10.1002/ppul.21126.
  25. Tagaya M, Nakata S, Yasuma F, et al. Relationship between adenoid size and severity of obstructive sleep apnea in preschool children. Int J Pediatr Otorhinolaryngol 2012;76(12):1827–1830. DOI: 10.1016/j.ijporl.2012.09.010.
  26. Øverland B, Berdal H, Akre H. Obstructive sleep apnea in 2-6 year old children referred for adenotonsillectomy. Eur Arch Otorhinolaryngol 2019;276(7):2097–2104. DOI: 10.1007/s00405-019-05362-3.
  27. Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2011;144(6):844–850. DOI: 10.1177/0194599811400683.
  28. Tang A, Benke JR, Cohen AP, et al. Influence of tonsillar size on OSA improvement in children undergoing adenotonsillectomy. Otolaryngol Head Neck Surg 2015;153(2):281–285. DOI: 10.1177/0194599815583459.
  29. Nuckton TJ, Glidden DV, Browner WS, et al. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep 2006;29(7):903–908. DOI: 10.1093/sleep/29.7.903.
  30. Su MS, Zhang HL, Cai XH, et al. Obesity in children with different risk factors for obstructive sleep apnea: a community-based study. Eur J Pediatr 2016;175(2):211–220. DOI: 10.1007/s00431-015-2613-6.
  31. Kljajic Z, Glumac S, Deutsch JA, et al. Feasibility study of determining a risk assessment model for obstructive sleep apnea in children based on local findings and clinical indicators. Int J Pediatr Otorhinolaryngol 2020;135:110081. DOI: 10.1016/j.ijporl.2020.110081.
  32. Camacho M, Capasso R, Schendel S. Airway changes in obstructive sleep apnoea patients associated with a supine versus an upright position examined using cone beam computed tomography. J Laryngol Otol 2014;128(9):824–830. DOI: 10.1017/S0022215114001686.
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