This study was funded by grants from the National Institutes of Health (NIH grants HD-53693 and HL-HL-62408). Sanjay R. Parikh, MD, is a consultant for Olympus. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Deep cervical lymph node hypertrophy: A new paradigm in the understanding of pediatric obstructive sleep apnea
Article first published online: 10 MAY 2013
© 2013 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 123, Issue 8, pages 2043–2049, August 2013
How to Cite
Parikh, S. R., Sadoughi, B., Sin, S., Willen, S., Nandalike, K. and Arens, R. (2013), Deep cervical lymph node hypertrophy: A new paradigm in the understanding of pediatric obstructive sleep apnea. The Laryngoscope, 123: 2043–2049. doi: 10.1002/lary.23748
- Issue published online: 19 JUL 2013
- Article first published online: 10 MAY 2013
- Manuscript Accepted: 24 AUG 2012
- Manuscript Revised: 16 JUL 2012
- Manuscript Received: 26 MAR 2012
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.
Prospective case control study.
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.
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).
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