Predictors of Severe Obstructive Sleep Apnea in Adolescents

INTRODUCTION: 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.