Une étude avait déjà démontré un pouvoir prédictif positif de souffrir du syndrome d’apnées obstructives du sommeil au fait de ne pas pouvoir faire le tour du cou avec ses propres mains1. Toutefois, cette étude n’a utilisé que des patients apnéiques. Une étude plus récente avec groupe contrôle a préféré mesurer la circonférence du cou à l’aide d’un ruban à mesurer et utiliser un ratio pour standardiser la circonférence du cou en fonction de la grandeur de la personne2. Il s’avère que la valeur prédictive d’un ratio supérieur à 0.25 n’est que de 25%. Toutefois, la valeur prédictive négative est de 96% lorsque le ratio est inférieur à 0.25. Cette mesure peut donc être utilisée pour éliminer la possibilité d’un SAOS.
Abstract
STUDY OBJECTIVES: While neck circumference (NC) is a useful predictor of obstructive sleep apnea (OSA) in adults, childhood OSA is difficult to predict clinically. We utilized the neck circumference-height ratio (NHR) to normalize NC in growing children. Our study aimed to determine if (1) NC is a reproducible clinical measurement; (2) NHR predicts OSA in children; (3) this metric translates to adults. METHODS: For this retrospective study, paired NC measurements (from clinic and sleep laboratory) in 100 consecutive adult subjects were used to confirm inter-observer reproducibility. Polysomnographic (PSG) and anthropometric data from children aged 5-18 years presenting consecutively between July 2007 and February 2012 was obtained. Children with genetic syndromes, severe neurological disorders, craniofacial abnormalities, tracheostomy, past adenotonsillectomy, in-hospital PSG or sleep efficiency < 80% were excluded. Data were analyzed using χ(2) test and logistic and linear regression models. These analyses were also applied to 99 adult patients with similar exclusion criteria. RESULTS: Adult NC measurement had inter-observer correlation of 0.85 (N = 100). Among children, after correcting for BMI-Z scores, NHR conferred additional predictive value, in both logistic regression and linear models, for both apnea-hypopnea index (AHI) > 2 and > 5 (N = 507). In children, for NHR > 0.25, the odds ratio of AHI > 2 was 3.47. In adults, for NHR > 0.25, the odds ratio of AHI > 5 was 18. CONCLUSIONS: NHR can be included as a simple screening tool for OSA in children and adults, which along with other predictors, may improve the ability of clinicians to triage children and adults at risk for OSA for further evaluation with PSG.