Study: Children's Neck-to-Waist ratio is predictor of sleep apnea!

This index has been used for adults for many years....

A study shows that a neck-to-waist ratio in children  0.41 is a predictor of sleep apnea.

Adults are not the only ones who develop sleep apnea. The condition occurs frequently in children as well. The statistics are quite staggering -- up to 66% of obese children are diagnosed with apnea compared with 5.7% of non-obese children. This is another reason to keep children active and help them make better food choices.

Just as with adults, the consequences ofsleep apnea can lead to other health issues. In children, learning and behavioral problems can be the first symptoms that suggest there is something happening in their sleep.

In adults, obstructive sleep apnea is the collapse of the pharyngeal tissue which causes obstruction of breathing during sleep. Children often develop sleep apnea because of large tonsils and adenoids. When a child is not sleeping well, ask his or her parents about snoring or if they can hear their child breathing from across the room. These are indications that tonsils and adenoids are hypertrophic.

As a provider, keep a measuring tape in your drawer can be helpful in determining whether your pediatric patient has obstructive sleep apnea. Research from Canada suggests that a neck-to-waist ratio of >0.41 has sufficient sensitivity and specificity to be considered a predictor of obstructive sleep apnea. The neck circumference is measured at the most prominent part of the thyroid cartilage and the waist circumference equidistant between the iliac crest and the lowest rib.

Of course, if you believe a child has obstructive sleep apnea it is important to order a polysomnogram to confirm the diagnosis. As it is often a concern, assure your patient that sleep labs have rooms set up for parents to stay with their child. Treatment may be as simple as removal of tonsils and adenoids, however, some children may need continuous positive airway pressure (CPAP) therapy. 

Children are not able to always put into words what they are feeling physically. As adults, we can say we are tired or fatigued, while children might not be able to do so. Ask parents how the child is interacting with other children or siblings. Are they falling asleep if not active? How are they doing in school? How is their behavior at home?

On your pediatric patient's next visit, remember to measure their neck and waist to see if they might need to a sleep study to assess for obstructive sleep apnea.

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New screening tool for sleep apnea in children

A new screening tool that looks at neck circumference in children can help screen for obstructive sleep apnea and sleep problems in children. 

Remember, the intent of "screening tools" is to find people at risk. They are not intended to be diagnostic. - JR

Clinical investigators at the Children's Hospital of Eastern Ontario (CHEO) have developed a new screening tool to help diagnose obstructive sleep apnea in children. Their findings are published in Pediatric Pulmonology.

Evidence suggests that adults with a large neck circumference are more likely to develop obstructive sleep apnea (OSA), especially males. As neck circumference varies by age and sex, there have been no reference ranges to diagnose pediatric OSA up until now. The new evidence-based diagnostic tool includes reference ranges—a new pediatric growth curve—to measure and track neck circumference for boys and girls between the ages of 6 and 17.

"The gold standard test (for OSA) is still a sleep study and we would not replace that, but because the wait is so long, we needed something quick and reliable to help bump kids up the priority list or to better understand who is at the highest risk for OSA," said Dr. Sherri Katz, principal investigator at the CHEO Research Institute and assistant professor in the Faculty of Medicine at the University of Ottawa. "If left untreated, OSA sets kids up for cardiovascular disease, diabetes and other comorbid conditions down the line."

The research team discovered for children, a neck circumference measuring greater than the 95th percentile for age and sex is associated with increased risk of OSA. When examined by sex, the association was significant in males aged 12 or older, but not in females. The research team also looked at Body Mass Index (BMI), but did not find that it stands alone as a significant predictor of OSA in this group.

"In older males, as in adults, neck size is a predictor of OSA. This suggests that in adults, it is not just overall obesity, but body fat distribution centrally—in the trunk and neck—that predicts the risk of OSA," said Katz.

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What increases risk for sleep apnea?

This article discusses 8 things and behaviors that can increase a person's risk for sleep apnea.

It used to be that if someone told you you snored, you shrugged it off as more of an annoyance to them than anything telling about your own health and wellbeing.

Today, we have a greater understanding of at least one potential risk of being a frequent snorer: You could have sleep apnea, a potentially harmful sleep disorder during which people stop breathing, sometimes hundreds of times a night.

Obstructive sleep apnea (OSA) is the most common type of sleep apnea, and occurs when the muscles in the back of the throat collapse, causing the opening through which air passes to disappear. (Watch this video for an in-depth explanation of what happens during OSA.)

But certain people are more likely to experience this interruption of breathing than others. We asked Dr. Matthew Mingrone, lead physician for EOS Sleep Centers in California specializing in sleep apnea and snoring issues, to help explain why.

Obesity
Likely the most indicative risk factor is carrying too much extra weight. Obese adults are seven times more likely to develop OSA than their normal-weight peers, according to WebMD. OSA is essentially a blockage of the upper airway, says Mingrone. Part of the tissue running from the nose to the voicebox collapses, cutting off the passage of oxygen. Excess weight adds to the pressure on tube, he says, making the diameter of the opening even smaller than it already is.

Neck Circumference

Obese people aren't the only demographic with larger-than-average necks. Consider the muscular build of professional athletes, for example, who aren't obese but thanks to muscle development are larger than us mere mortals.

Men with a neck circumference greater than 17 inches and women over 15 inches have a higher risk of OSA, WebMD reported.

Age
People of any age can develop sleep apnea, but the condition is more common the older you get, according to the National Heart Lung and Blood Institute. "As we get older, we lose tone and elasticity as part of the normal aging process," says Mingrone. With that natural softening of the tissue in the throat, there's higher likelihood of collapse, he says.

Family History
It's not that you have a genetic predisposition to developing sleep apnea, says Mingrone, like a specific type of cancer that may run in families. Instead, it's likely that you've inherited certain aspects of your physical makeup that increase sleep apnea risk, he says. If Mom's being treated for sleep apnea and you've inherited her narrow jaw, you may have a similar doctor's visit in your future.

Alcohol Use

Because it's a muscle relaxant, alcohol too close to bedtime can lead to episodes of apnea, says Mingrone, even in someone who doesn't have OSA. And in those with the disorder, alcohol can lengthen the duration of apnea episodes, according to the National Institute on Alcohol Abuse and Alcoholism.

Race
Studies show that both sleep apnea risk and sleep apnea severity vary by race. It may be due to anatomical differences in the airways of different ethnic groups, according to Mingrone.

Smoking

Current smokers are 2.5 times more likely to have OSA than smokers and nonsmokers combined, according to a 2001 study. "Smoking most airway tissue swell because it's an irritant," says Mingrone. Swelling in the nose and the throat further reduces the space for air to flow through.

Gender
Middle-aged men are twice as likely to have OSA than women of the same age, according to the American Lung Association. Mingrone says in his practice, about 15 to 20 percent of patients are female. The variance may be due again to anatomical differences, especially since men are simply bigger than women more often than not.

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