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Laryngoscope. 2013 Aug;123(8):2043-9. doi: 10.1002/lary.23748. Epub 2013 May 10.

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

Author information

  • 1Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital-University of Washington School of Medicine, Seattle, Washington 98105, USA. sanjay.parikh@seattlechildrens.org

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/m(2)). 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 mm(3), P < 0.001), upper jugular region (22202 vs. 16819 mm(3), P < 0.005), and adenotonsillar region (18994 vs. 12675 mm(3), 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.

KEYWORDS:

MRI; apnea; children; etiology; sleep

PMID:
23666635
PMCID:
PMC3720839
DOI:
10.1002/lary.23748
[PubMed - indexed for MEDLINE]
Free PMC Article
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