PURPOSE: Clinical evaluation has historically been considered insufficient to differentiate Obstructive Sleep Apnea (OSA) from Primary Snoring Disorder (PSD) in children. We identify clinical parameters that may help differentiate these disorders to determine the need for polysomnography.
METHODS: Consecutive polysomnograms of patients ages 6 through 17 studied between 1999 and 2005 were retrospectively reviewed. Histories and exams prior to polysomnography were evaluated for daily caffeine intake, height, weight, blood pressure, neck circumference, and tonsillar hypertrophy. Additionally, age and gender based percentiles were calculated for height, BMI, and blood pressure. OSA was defined as an obstructive apnea-hypopnea index > 1.
RESULTS: 309 patient charts were reviewed. 90 patients were categorized as “normal” (no OSA or PSD), 106 had OSA, and 113 had PSD.Significant differences existed between PSD and OSA patients in BMI (28.7 in OSA vs. 22.0 in PSD; p < 0.0001), BMI percentile (86.7% in OSA vs. 75.3% in PSD; p = 0.008), neck circumference (36.0 in OSA vs. 31.7 in PSD; p = 0.0001), and presence of tonsillar hypertrophy (88 % of OSA vs. 72% of PSD; p = 0.003). No significant differences existed in caffeine intake, height, and blood pressure.Significant differences existed between normal and OSA patients in BMI (24.1 in normals vs. 28.7 in OSA; p = 0.002), BMI percentile (77.4% in normals vs. 86.7% in OSA; p = 0.003), and presence of tonsillar hypertrophy (50% of normals vs. 88% of OSA; p < 0.0001). No significant differences existed in caffeine intake, height, neck circumference, and blood pressure. A significant difference in the presence of tonsillar hypertrophy existed between normal and PSD patients (50% of normals vs. 72% of PSD; p = 0.0013). There were no significant differences in caffeine intake, height, BMI, percentile BMI, neck circumference, and blood pressure.
CONCLUSION: Significant differences exist between patients with OSA vs. PSD in BMI, neck circumference and tonsil size.
CLINICAL IMPLICATIONS: Specific clinical parameters may help identify pediatric patients who need polysomnography and differentiate those with OSA from PSD.
DISCLOSURE: Nisha Rathi, None.