Browsing by Author "Scott, Brian"
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Item Obstructive Sleep Apnea (OSA): Differences Between Normal-Weight, Overweight, Obese and Morbidly Obese Children(2015-01-26) Scott, Brian; Johnson, Romaine; Mitchell, RonThe severity of obstructive sleep apnea (OSA) in children determines perioperative management and is an indication for postoperative polysomnography (PSG). There is a paucity of data on differences and predictors of OSA severity in children in different weight categories. The primary objective was to compare demographic, clinical and polysomnography parameters in normal-weight, overweight, obese and morbidly obese children and to identify factors that are associated with OSA severity. Healthy children aged 2-18 who underwent polysomnography at an academic children's hospital were included in the study. Demographics, clinical findings, and polysomnogram parameters were recorded. Children were categorized as normal-weight, overweight, obese, or morbidly obese based on CDC criteria. Differences were assessed with linear and logistical regression models. Significance was set at p<0.05. 290 children were included. Morbidly obese were older than normal-weight children (mean 8.0±0.5 versus 5.8±0.3; p<0.001) but less likely to have a normal PSG (16% versus 48%; p=0.02). There were no differences in gender, ethnicity, birth status (term or pre-term), tonsil size or AHI between the different weight categories. Sleep efficiency and %REM were decreased in morbidly obese children (p<0.05). The AHI was positively correlated with increasing BMI z-score as a function of increasing age (p<0.001). There are important differences in children with OSA in different weight categories. OSA severity is correlated with a combination of increasing age and weight but not with either variable independently. This study suggests that obese and morbidly obese older children are most likely to have severe OSA and should undergo routine PSG.Item Predictors of Severe Obstructive Sleep Apnea in Adolescents(2016-01-19) Baker, Mark; Scott, Brian; Johnson, Romaine; Mitchell, RonINTRODUCTION: Obstructive sleep apnea (OSA) is a growing health problem in the adolescent population yet risk factors for severe OSA in this group remain poorly understood. The objective of this study was to evaluate clinical and demographic risk factors for severe OSA in adolescents. METHODS: Healthy children aged 12-18 who underwent overnight polysomnography (PSG) at an academic children's hospital were included. Obesity was defined as BMI ≥95th percentile. Severe OSA was defined as an apnea hypopnea index (AHI) ≥ 10. Significance was set at p<0.05. Demographic, clinical, and PSG parameters were recorded. Multivariate linear and logistical regression analysis was performed to investigate parameters that predicted the AHI and presence of severe OSA. RESULTS: 258 adolescents, 54% male and 46% female were included in the study. The mean age was 14.7 years with an ethnic breakdown of 53% Hispanic, 30% African American, and 14% Caucasian. The mean AHI was 14.9 (SD 28.2). Regression analysis showed that obesity (β=10.5, p=0.001) and tonsil size (3/4 versus 1/ 2; β=16.3, p<0.001) correlated with increasing AHI. Severe OSA was predicted by obesity (OR=3.6; p<0.001), male gender (OR=2.5; p=0.003), and tonsil size (3/4 versus 1/ 2; OR= 3.5; p≤0.001). An obese male with 3/4 tonsils would have an 80% chance of having severe OSA. Age and ethnicity were not associated with severe OSA. CONCLUSIONS: Severe OSA in adolescents is associated with male gender, obesity and tonsillar hypertrophy. This study supports routine PSG in obese males with tonsillar hypertrophy to identify and treat severe OSA.