0
Original Research |

Upper Airway Lymphoid Tissue Size in Children With Sickle Cell DiseaseAirway Lymphoid Tissue Size in Sickle Cell Disease

Temima Strauss, BA; Sanghun Sin, MS; Carole L. Marcus, MBBCh, FCCP; Thornton B. A. Mason, MD, PhD; Joseph M. McDonough, MS; Julian L. Allen, MD; Jason B. Caboot, MD; Cheryl Y. Bowdre, PhD; Abbas F. Jawad, PhD; Kim Smith-Whitley, MD; Kwaku Ohene-Frempong, MD; Allan I. Pack, MD, PhD; Raanan Arens, MD
Author and Funding Information

From the Division of Respiratory and Sleep Medicine (Ms Strauss, Mr Sin, and Dr Arens), The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY; the Sleep Center (Drs Marcus and Mason), Division of Pulmonary Medicine (Mr McDonough and Drs Allen and Caboot), Division of Hematology (Drs Bowdre, Smith-Whitley, and Ohene-Frempong), and Division of Pediatrics (Dr Jawad), The Children’s Hospital of Philadelphia, and the Center for Sleep and Circadian Neurobiology (Dr Pack), University of Pennsylvania School of Medicine, Philadelphia, PA.

Correspondence to: Raanan Arens, MD, Division of Respiratory and Sleep Medicine, Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467; e-mail: rarens@montefiore.org

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Marcus has funding from Phillips Respironics (not related to the current project) and Dr Pack received an endowed chair from the Respironics Foundation (not related to the current project). Ms Strauss, Messrs Sin and McDonough, and Drs Mason, Allen, Caboot, Bowdre, Jawad, Smith-Whitley, Ohene-Frempong, and Arens have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Funding/Support: Funded by National Institutes of Health [Grants HL-62408 and HL-79911].


Funding/Support: Funded by National Institutes of Health [Grants HL-62408 and HL-79911].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):94-100. doi:10.1378/chest.11-2013
Text Size: A A A
Published online

Background:  The prevalence of obstructive sleep apnea syndrome (OSAS) is higher in children with sickle cell disease (SCD) as compared with the general pediatric population. It has been speculated that overgrowth of the adenoid and tonsils is an important contributor.

Methods:  The current study used MRI to evaluate such an association. We studied 36 subjects with SCD (aged 6.9 ± 4.3 years) and 36 control subjects (aged 6.6 ± 3.4 years).

Results:  Compared with control subjects, children with SCD had a significantly smaller upper airway (2.8 ± 1.2 cm3 vs 3.7 ± 1.6 cm3, P < .01), and significantly larger adenoid (8.4 ± 4.1 cm3 vs 6.0 ± 2.2 cm3, P < .01), tonsils (7.0 ± 4.3 cm3 vs 5.1 ± 1.9 cm3, P < .01), retropharyngeal nodes (3.0 ± 1.9 cm3 vs 2.2 ± 0.9 cm3, P < .05), and deep cervical nodes (15.7 ± 5.7 cm3 vs 12.7 ± 4.0 cm3, P < .05). Polysomnography showed that 19.4% (seven of 36) of children with SCD had OSAS compared with 0% (zero of 20) of control subjects (P < .05) and that in children with SCD the apnea-hypopnea index correlated positively with upper airway lymphoid tissues size (r = 0.57, P < 001). In addition, children with SCD had lower arterial oxygen saturation nadir (84.3% ± 12.3% vs 91.2% ± 4.2%, P < .05), increased peak end-tidal CO2 (53.4 ± 8.5 mm Hg vs 42.3 ± 5.3 mm Hg, P < .001), and increased arousals (13.7 ± 4.7 events/h vs 10.8 ± 3.8 events/h, P < .05).

Conclusions:  Children with SCD have reduced upper airway size due to overgrowth of the surrounding lymphoid tissues, which may explain their predisposition to OSAS.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543