Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug;123(8):2043-9.
doi: 10.1002/lary.23748. Epub 2013 May 10.

Deep cervical lymph node hypertrophy: a new paradigm in the understanding of pediatric obstructive sleep apnea

Sanjay R Parikh  1 , Babak Sadoughi, Sanghun Sin, Seth Willen, Kiran Nandalike, Raanan Arens
Affiliations

Deep cervical lymph node hypertrophy: a new paradigm in the understanding of pediatric obstructive sleep apnea

Sanjay R Parikh et al. Laryngoscope. 2013 Aug.

Abstract

Objectives/hypothesis: To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy.

Study design: Prospective case control study.

Methods: A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data.

Results: Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m(2)). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2 , and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm(3), P < 0.001), upper jugular region (22202 vs. 16819 mm(3), P < 0.005), and adenotonsillar region (18994 vs. 12675 mm(3), P < 0.0001).

Conclusions: Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care.

Keywords: MRI; apnea; children; etiology; sleep.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interests:

Parikh: Consultant, Olympus

Figures

Figure 1
Figure 1
MRI volumetric analysis of lymphoid tissue volumes in an OSA patient (green-upper jugular lymph nodes, orange-tonsil tissue, red-retropharyngeal lymph nodes, magenta- adenoid tissue). A. Three dimensional reconstruction of lymphoid tissue using Amira® software. B. Axial T2-weighted DICOM image with lymphoid tissue tracings. C. Coronal T2-weighted DICOM image with lymphoid tissue tracings. D. Sagittal T2-weighted DICOM image with lymphoid tissue tracings.
Figure 2
Figure 2
Comparison of retropharyngeal lymph node volumes in OSA patients and controls (95% confidence intervals).
Figure 3
Figure 3
Comparison of upper jugular lymph node volumes in OSA patients and controls (95% confidence intervals).
Figure 4
Figure 4
Comparison of total deep cervical lymph node volumes in OSA patients and controls (95% confidence intervals).
Figure 5
Figure 5
Figure 5a & 5b. Scatter plots and coefficient correlation between total deep cervical lymph node volume and age with linear trends in OSA subjects (top) and controls (bottom).
Figure 5
Figure 5
Figure 5a & 5b. Scatter plots and coefficient correlation between total deep cervical lymph node volume and age with linear trends in OSA subjects (top) and controls (bottom).
Figure 6
Figure 6
Scatter plot and coefficient correlation between AHI and subjects total deep cervical node volume.
Figure 7
Figure 7
Scatter plot and coefficient correlation between AHI and combined subject lymphoid tissue volumes(tonsils, adenoid, retropharyngeal lymph nodes and upper jugular lymph nodes)
See this image and copyright information in PMC

References

    1. Witmans M, Young R. Update on pediatric sleep-disordered breathing. Pediatr Clin North Am. 2011;58:571–89. - PubMed
    1. Halbower AC, Ishman SL, McGinley BM. Childhood obstructive sleep-disordered breathing: a clinical update and discussion of technological innovations and challenges. Chest. 2007;132:2030–41. - PubMed
    1. Gozal D, Kheirandish-Gozal L. New approaches to the diagnosis of sleep-disordered breathing in children. Sleep Med. 2010;11:708–13. - PubMed
    1. Wise MS, Nichols CD, Grigg-Damberger MM, et al. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep. 2011;34:389–98. - PMC - PubMed
    1. Aurora RN, Zak RS, Karippot A, et al. Practice parameters for the respiratory indications for polysomnography in children. Sleep. 2011;34:379–88. - PMC - PubMed

Publication types

LinkOut - more resources