Analysis of the Risk Factors Associated With Obstructive Sleep Apnea Syndrome in Chinese Children

Objective

The present study was developed to explore risk factors related to the incidence and severity of obstructive sleep apnea syndrome (OSAS) in children.

Methods

The present study enrolled pediatric patients who admitted to our department for snoring and/or open-mouth breathing. All children completed a questionnaire and underwent physical examination and polysomnography (PSG). The cases were separated into OSAS and primary snoring (PS) groups. Factors associated with these two groups were analyzed, with risk factors significantly associated with OSAS then being identified through logistic regression analyses. OSAS was further subdivided into mild, moderate, and severe subgroups, with correlations between risk factors and OSAS severity then being analyzed.

Results

In total, 1,550 children were included in the present study, of which 852 and 698 were enrolled in the OSAS and PS groups. In univariate analyses, obesity, family passive smoking, a family history of snoring, allergic rhinitis, asthma, adenoid hypertrophy, and tonsil hypertrophy were all related to pediatric OSAS (P < 0.05). In a multivariate logistic regression analysis, adenoid hypertrophy (OR:1.835, 95% CI: 1.482-2.271) and tonsil hypertrophy (OR:1.283, 95% CI:1.014-1.622) were independently associated with the risk of pediatric OSAS (P < 0.05). Stratification analyses revealed that OSAS incidence increased in a stepwise manner with increases in adenoid and tonsil grading (P < 0.01). Correlation analyses revealed that adenoid hypertrophy and tonsilar hypertrophy were not significantly associated with OSAS severity (r = 0.253, 0.069, respectively, P < 0.05), and tonsil and adenoid size were no correlation with obstructive apnea-hypopnea index (OAHI) (r = 0.237,0.193, respectively, P < 0.001).

Conclusion

Obesity, family passive smoking, a family history of snoring, allergic rhinitis, asthma, tonsil hypertrophy, and adenoid hypertrophy may be potential risk factors for pediatric OSAS. Adenoid hypertrophy and tonsil hypertrophy were independently related to the risk of pediatric OSAS, with OSAS incidence increasing with the size of the adenoid and tonsil, while the severity of OSAS is not parallel related to the adenoid or tonsil size.

[Diagnosis and correction of the obstructive sleep apnea syndrome in children with tonsillar ring pathological conditions]

OBJECTIVE

To summarize the results of a study of the clinical and polygrapic features of sleep in children with pathologic conditions of the tonsillar ring and obstructive sleep apnea. Tonsillar hypertrophy is the most common cause of obstructive sleep apnea in children. Using the data of overnight polysomnographic study and/or nocturnal pulse oximetry, groups of patients were distinguished depending on the presence and severity of their sleep breathing disorders. The effectiveness of adenotomy, adenotonsillotomy and/or adenotonsillectomy in children is demonstrated, depending on the severity of obstructive sleep apnea syndrome. Evaluation of breathing in sleeping children by polygraphic methods is necessary for early detection of obstructive sleep apnea syndrome and monitoring the effectiveness of surgical treatment.

Preliminary study on the feasibility of a two-stage screening strategy for otitis media with effusion in children

AIM

To evaluate the feasibility of a two-stage screening strategy for otitis media with effusion (OME) in pre-school and school children. The risk factors of OME were also studied.

METHODS

One hundred and eighty-nine children aged 4-8 years were recruited. The two-stage screening consisted of an on-site screening with a portable otoscopy along with a questionnaire to both diagnose children with OME and identify children at risk, and a standard screening performed at a regional hospital for final diagnosis. The prevalence detected from the two-stage screening approach was compared to the actual prevalence.

RESULTS

The detection rate of OME through the two-stage screening approach was not significantly different from the actual prevalence rate (12.7% vs. 13.4%, P = 0.847). Children from the urban area had a lower risk for OME than that from the rural area (P = 0.007, odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.11-0.74). Compared to childcare dining, family dining helped to reduce the chance of OME (P < 0.001, OR = 0.15, 95% CI: 0.06-0.38).

CONCLUSIONS

The two-stage screening strategy was effective for screening for OME among pre-school and school children. It can be used in rural areas that have a high prevalence of OME and limited medical resources.

[Retrospective analysis of the four kinds of virus in adeno tonsillar tissues from children using PCR]

Objective:To investigate the seasonal disturbations and the rates of detection of EpsteinBarr virus (EBV), Human Bocavirus(HBoV), and polyomaviruses KI and WU (KIPyV and WUPyV) in adenoid and tonsil tissues during the absence of acute infection symptoms.Method:DNA expressions of EBV, HBoV, polyomaviruses KIPyV and WUPyV were investigated in children with chronic tonsillar and adenoidal diseases using real time polymerase chain reaction. The patients were divided into three group: adenoid group, chronic tonsillit group and hypertrophic tonsillitis group. The relationships of the expressions of these viruses with age, gender, recurrent infection and airway obstruction were analyzed. Seasonal variations in rates of detection of these viruses in adenoid and tonsil tissues were also investigated.Result:Considering adenoid specimens, HBoV was found to be the most frequent virus with the rate of 43.1%. In specimens of chronic tonsillitis and hypertrophic tonsils, EBV was the most frequently encountered virus (53.8%, and 32.0%, respectively). In children with hypertrophic adenoids, while HBoV was detected to be positive throughout the year, EBV was present throughout the year in children with recurrent tonsillitis.Conclusion:The detection of HBoV and EBV throughout the year in samples of children with asymptomatic chronic adenotonsillar diseases may indicate that these viruses may remain persistently in lymphoepithelial tissues of upper respiratory tract. Virus persistence may have a pathogenetic potential for development of lymphoid hypertrophy and a chronic stimulatory effect for inflammation.