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

Authors

  • Sanjay R. Parikh MD FACS,

    Corresponding author
    • Department of Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital–University of Washington School of Medicine, Seattle, Washington
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  • Babak Sadoughi MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Children's Hospital at Montefiore–Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • Sanghun Sin MS,

    1. Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore–Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • Seth Willen MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Children's Hospital at Montefiore–Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • Kiran Nandalike MD,

    1. Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore–Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • Raanan Arens MD

    1. Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore–Albert Einstein College of Medicine, Bronx, New York, U.S.A.
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  • 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.

Send correspondence to Sanjay R. Parikh, MD, FACS, Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, W-7729, Seattle WA 98105. E-mail: 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/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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