Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome

Raanan Arens, Sanghun Sin, Kiran Nandalike, Jessica Rieder, Unab I. Khan, Katherine Freeman, Judith Wylie-Rosett, Michael L. Lipton, David M. Wootton, Joseph M. McDonough, Keivan Shifteh

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Rationale: Mechanisms leading to obstructive sleep apnea syndrome (OSAS) in obese children are not well understood. Objectives: The aim of the study was to determine anatomical risk factors associated with OSAS in obese children as compared with obese control subjects without OSAS. Methods: Magnetic resonance imaging was used to determine the size of upper airway structure, and body fat composition. Paired analysis was used to compare between groups. Mixed effects regression models and conditional multiple logistic regression models were used to determine whether body mass index (BMI) Z-score was an effect modifier of each anatomic characteristic as it relates to OSAS. Measurements and Main Results: We studied 22 obese subjects with OSAS (12.5 ± 2.8 yr; BMI Z-score, 2.4 ± 0.4) and 22 obese control subjects (12.3 ± 2.9 yr; BMI Z-score, 2.3 ± 0.3). As compared with control subjects, subjects with OSAS had a smaller oropharynx (P< 0.05) and larger adenoid (P < 0.01), tonsils (P< 0.05), and retropharyngeal nodes (P<0.05). The size of lymphoid tissues correlated with severity of OSAS whereas BMI Z-score did not have a modifier effect on these tissues. Subjects with OSAS demonstrated increased size of parapharyngeal fat pads (P<0.05) and abdominal visceral fat (P<0.05). The size of these tissues did not correlate with severity of OSASandBMIZ-score did not have a modifier effecton these tissues. Conclusions: Upper airway lymphoid hypertrophy is significant in obese children with OSAS. The lack of correlation of lymphoid tissue size with obesity suggests that this hypertrophy is caused by other mechanisms. Although the parapharyngeal fat pads and abdominal visceral fat are larger in obese children with OSAS we could not find a direct association with severity of OSAS or with obesity.

Original languageEnglish (US)
Pages (from-to)782-787
Number of pages6
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume183
Issue number6
DOIs
StatePublished - Mar 15 2011
Externally publishedYes

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Obstructive Sleep Apnea
Body Composition
Adipose Tissue
Body Mass Index
Intra-Abdominal Fat
Lymphoid Tissue
Hypertrophy
Obesity
Logistic Models
Adenoids
Oropharynx
Palatine Tonsil
Magnetic Resonance Imaging

Keywords

  • Lymphoid hypertrophy
  • MRI
  • Obese children

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome. / Arens, Raanan; Sin, Sanghun; Nandalike, Kiran; Rieder, Jessica; Khan, Unab I.; Freeman, Katherine; Wylie-Rosett, Judith; Lipton, Michael L.; Wootton, David M.; McDonough, Joseph M.; Shifteh, Keivan.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 183, No. 6, 15.03.2011, p. 782-787.

Research output: Contribution to journalArticle

Arens, R, Sin, S, Nandalike, K, Rieder, J, Khan, UI, Freeman, K, Wylie-Rosett, J, Lipton, ML, Wootton, DM, McDonough, JM & Shifteh, K 2011, 'Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome', American Journal of Respiratory and Critical Care Medicine, vol. 183, no. 6, pp. 782-787. https://doi.org/10.1164/rccm.201008-1249OC
Arens, Raanan ; Sin, Sanghun ; Nandalike, Kiran ; Rieder, Jessica ; Khan, Unab I. ; Freeman, Katherine ; Wylie-Rosett, Judith ; Lipton, Michael L. ; Wootton, David M. ; McDonough, Joseph M. ; Shifteh, Keivan. / Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome. In: American Journal of Respiratory and Critical Care Medicine. 2011 ; Vol. 183, No. 6. pp. 782-787.
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abstract = "Rationale: Mechanisms leading to obstructive sleep apnea syndrome (OSAS) in obese children are not well understood. Objectives: The aim of the study was to determine anatomical risk factors associated with OSAS in obese children as compared with obese control subjects without OSAS. Methods: Magnetic resonance imaging was used to determine the size of upper airway structure, and body fat composition. Paired analysis was used to compare between groups. Mixed effects regression models and conditional multiple logistic regression models were used to determine whether body mass index (BMI) Z-score was an effect modifier of each anatomic characteristic as it relates to OSAS. Measurements and Main Results: We studied 22 obese subjects with OSAS (12.5 ± 2.8 yr; BMI Z-score, 2.4 ± 0.4) and 22 obese control subjects (12.3 ± 2.9 yr; BMI Z-score, 2.3 ± 0.3). As compared with control subjects, subjects with OSAS had a smaller oropharynx (P< 0.05) and larger adenoid (P < 0.01), tonsils (P< 0.05), and retropharyngeal nodes (P<0.05). The size of lymphoid tissues correlated with severity of OSAS whereas BMI Z-score did not have a modifier effect on these tissues. Subjects with OSAS demonstrated increased size of parapharyngeal fat pads (P<0.05) and abdominal visceral fat (P<0.05). The size of these tissues did not correlate with severity of OSASandBMIZ-score did not have a modifier effecton these tissues. Conclusions: Upper airway lymphoid hypertrophy is significant in obese children with OSAS. The lack of correlation of lymphoid tissue size with obesity suggests that this hypertrophy is caused by other mechanisms. Although the parapharyngeal fat pads and abdominal visceral fat are larger in obese children with OSAS we could not find a direct association with severity of OSAS or with obesity.",
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AU - Freeman, Katherine

AU - Wylie-Rosett, Judith

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