Deep cervical lymph node hypertrophy: A new paradigm in the understanding of pediatric obstructive sleep apnea

Sanjay R. Parikh, Babak Sadoughi, Sanghun Sin, Seth Willen, Kiran Nandalike, Raanan Arens

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives/Hypothesis To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy. Study Design Prospective case control study. Methods A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data. Results Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m2). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2, and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm3, P < 0.001), upper jugular region (22202 vs. 16819 mm3, P < 0.005), and adenotonsillar region (18994 vs. 12675 mm3, P < 0.0001). Conclusions Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care. Level of Evidence 3b. Laryngoscope, 123:2043-2049, 2013

Original languageEnglish (US)
Pages (from-to)2043-2049
Number of pages7
JournalLaryngoscope
Volume123
Issue number8
DOIs
StatePublished - Aug 2013

Fingerprint

Obstructive Sleep Apnea
Hypertrophy
Lymph Nodes
Pediatrics
Polysomnography
Lymphoid Tissue
Sleep
Laryngoscopes
Sleep Apnea Syndromes
Apnea
Chi-Square Distribution
Arousal
Case-Control Studies
Body Mass Index
Neck
Demography
Prospective Studies
Students
Weights and Measures

Keywords

  • apnea
  • children
  • etiology
  • MRI
  • sleep

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Deep cervical lymph node hypertrophy : A new paradigm in the understanding of pediatric obstructive sleep apnea. / Parikh, Sanjay R.; Sadoughi, Babak; Sin, Sanghun; Willen, Seth; Nandalike, Kiran; Arens, Raanan.

In: Laryngoscope, Vol. 123, No. 8, 08.2013, p. 2043-2049.

Research output: Contribution to journalArticle

Parikh, Sanjay R. ; Sadoughi, Babak ; Sin, Sanghun ; Willen, Seth ; Nandalike, Kiran ; Arens, Raanan. / Deep cervical lymph node hypertrophy : A new paradigm in the understanding of pediatric obstructive sleep apnea. In: Laryngoscope. 2013 ; Vol. 123, No. 8. pp. 2043-2049.
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abstract = "Objectives/Hypothesis To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy. Study Design Prospective case control study. Methods A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data. Results Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m2). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2, and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm3, P < 0.001), upper jugular region (22202 vs. 16819 mm3, P < 0.005), and adenotonsillar region (18994 vs. 12675 mm3, P < 0.0001). Conclusions Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care. Level of Evidence 3b. Laryngoscope, 123:2043-2049, 2013",
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AB - Objectives/Hypothesis To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy. Study Design Prospective case control study. Methods A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data. Results Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m2). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2, and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm3, P < 0.001), upper jugular region (22202 vs. 16819 mm3, P < 0.005), and adenotonsillar region (18994 vs. 12675 mm3, P < 0.0001). Conclusions Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care. Level of Evidence 3b. Laryngoscope, 123:2043-2049, 2013

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