Risk factors of obstructive sleep apnea syndrome in obese early adolescents: a prediction model using scoring system

Abstract

Aim: to obtain the OSAS prevalence and risk factors of OSAS in obese early adolescents and to create a scoring system based on risk factors for diagnosing OSAS.

Methods: an observational study in Jakarta, November 2007 until December 2008 on obese adolescents aged 10-12 years with snoring. Subjects underwent clinical examination, lung function test, paranasal sinus X-ray, and polisomnography. Measured outcomes were diagnosis of OSAS; sensitivity, specificity, predictive values, and likelihood ratios of a scoring system based on risk factors.

Results: the prevalence of OSAS in obese early adolescents is 38.2% using AHI cut-off point of ≥3 on PSG. Tonsillar hypertrophy, adenoid hypertrophy, and neck circumference were the main risk factors. Scoring system was designed based on these results: OS= T + A + NC; OS= OSAS score; T= tonsil hypertrophy (≥T3 scored 1, <T3 scored 0); A = adenoid hypertrophy (adenoid and nasopharynx ratio of ≥0.8 scored 1.5, <0.8 scored 0); NC = neck circumference (≥34 cm scored 1; <34 cm scored 0). Children were most likely to have OSAS if they had a total score of 3.5. This scoring system has a sensitivity of 62% (95%CI 47 to 77%), specificity 100% (95%CI 100 to 100%), positive predictive value 100% (95%CI 100 to 100%), negative predictive value 81% (95%CI 73 to 89%), unlimited LR(+), LR(-) of 0.38 (CI 95% 0.6 to 0.56).

Conclusion: a scoring system based on tonsillar hypertrophy, adenoid hypertrophy, and neck circumference has sensitivity and specificity of 62% and 100% in diagnosing OSAS.