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Objective: To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA)., Study Design: Case series study., Methods: Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability., Results: A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status., Conclusions: OSA in children is associated with increased BP and BP variability., Level of Evidence: 4 Laryngoscope, 131:2126-2132, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To develop a clinical risk prediction model that identifies children with obstructive sleep apnea (OSA) in a clinical setting by examining the symptoms, physical status, and OSA-18 questionnaire results., Design: Single institutional, cross-sectional study., Methods: Children aged 2 to 18 years with symptoms of OSA were enrolled. Pediatric OSA was diagnosed through full-night polysomnography. Clinical data, namely demographics, symptoms, OSA-18 survey results, tonsil and adenoid sizes, and the weight of each child, were examined for constructing a simple point-based clinical model for OSA prediction. Variables for the risk model were selected using multivariable logistic regression analyses., Results: Of the 310 participants (mean age, 7.6 ± 3.7 years; boys, 67%), 170 (55%) experienced OSA. Modeling variables were determined using several univariate logistic regression analyses, followed by multivariable logistic regression analyses. A point-based clinical model incorporating the age, tonsil size (5 points maximum), adenoid size (5 and 20 points for age > 6 years and < 6 years, respectively), obesity (5 points for age > 6 years), and breathing pauses (5 points) was developed (area under the curve = 0.832). Moreover, the optimal cutoff points for predicting the apnea-hypopnea index of > 1 and > 5 were 10 (sensitivity, 72.9%; specificity, 65.0%) and 12 (sensitivity, 77.5%; specificity, 56.9%), respectively. Internal validation using the bootstrap method revealed no apparent overfitting problem., Conclusion: A novel clinical prediction model was developed for determining the risk of pediatric OSA; the model can be useful in identifying high-risk patients among those with sleep disturbances., Level of Evidence: 4. Laryngoscope, 126:2403-2409, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

The prevalence rate of obstructive sleep apnea (OSA) in the community Down syndrome (DS) children is not clear. Moreover, the impact of OSA and sleep structure on the cognitive function is inconclusive. The present study aimed to investigate 1) the prevalence rate of OSA in the community DS children and 2) the impact of OSA and sleep structure on cognitive performance. Thirty DS children aged 6–18 years were recruited and evaluated with the performance of the language domain and sensorimotor domain, combining neuropsychological tests and parent-rated behavior. The outcomes were the age-adjusted scores, of which the lower the score was, the better was the patient's ability. The association of score with OSA and sleep structures was determined by linear regression. To diminish the age-related difference, all analyses were conducted separately for all subjects and 6–12-year-old subjects. The median age was 11.3 years and median Full-Scale Intelligence Quotient (FSIQ) was 44. The prevalence of OSA (apnea–hypopnea index ≥ 1/h) was 80% and 62.5% in all subjects and 6–12-year-old subjects, respectively. For 6–12-year-old subjects, after adjustment for age and FSIQ, both %REM and OSA were associated with lower score of the subtest of language domain, WPPSI-R Vocabulary, while %REM was also associated with lower score of VABS-II Communication – Expressive. In contrary, % slow wave sleep was not associated with any subtest. This study identified that OSA may be highly prevalent in community DS children. Among 6–12-year-old DS children, OSA and % REM were associated with their language function. [ABSTRACT FROM AUTHOR]

Objective: To investigate 24-hour ambulatory blood pressure changes 6 months after surgery among children with obstructive sleep apnea.Study Design: Prospective interventional study.Setting: Tertiary medical hospital.Subjects and Methods: Children aged 4 to 16 years with symptoms of obstructive sleep apnea (apnea-hypopnea index >1) were recruited. All children underwent adenotonsillectomy and postoperative polysomnography overnight. The 24-hour ambulatory blood pressure was measured before and 6 months after surgery.Results: The study cohort enrolled 124 children: mean (SD) age, 7.3 (3.1) years; 73% boys. After surgery, the apnea-hypopnea index significantly decreased from 13.3 (18.1) to 3.3 (7.2) events per hour ( P < .001). Overall systolic blood pressure and diastolic blood pressure were not significantly different following surgery, while daytime systolic blood pressure was slightly increased (114.3 to 117.3 mm Hg, P < .01) postoperatively. The hypertensive group (n = 43) exhibited significantly decreased levels of overall diastolic, nighttime systolic, and nighttime diastolic blood pressure ( P < .05), and 54% of hypertensive children became nonhypertensive after surgery. The nonhypertensive group (n = 81) showed slightly increased levels of nocturnal overall systolic, daytime systolic, and nighttime systolic blood pressure. A generalized linear mixed model revealed that children with hypertension had a greater decrease in systolic and diastolic ambulatory blood pressure during the daytime and nighttime (all P < .05) than those without hypertension.Conclusions: Ambulatory blood pressure changes after adenotonsillectomy among children with obstructive sleep apnea are minimal. The decrease in ambulatory blood pressure after surgery is more prominent for hypertensive children than nonhypertensive children. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To investigate the effects of diseases severity on postoperative complications following adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB).Study Design: Retrospective study.Methods: Children aged <18 years were enrolled and underwent T&A for treating SDB. Polysomnography was used to classify the disease severity: primary snoring (apnea-hypopnea index [AHI] <1), mild (AHI = 1-5), moderate (AHI = 5-10), and severe obstructive sleep apnea [OSA] (AHI ≥10). Postoperative bleeding was graded using a severity scale (level I, self-reported bleeding; level II, requiring inpatient admission; level III, requiring reoperation). Primary bleeding is defined as hemorrhage occurring within the initial 24 postoperative hours. Perioperative respiratory complications are defined as oxygen saturation of less than 90%, 92%, or 95% in the recovery room. Major respiratory complications include laryngospasm, pulmonary edema, pneumonia, and intubation at recovery stage.Results: A total of 610 children were included, of whom 42 (6.9%), eight (1.3%), and six (1.0%) children showed levels I, II, and III postoperative bleeding, respectively. Only one child had primary bleeding. The incidence and timing of postoperative bleeding did not differ significantly for children with different OSA severities. The rate of perioperative respiratory complications ranged from 1.6% to 14.3% on the basis of their definitions. The Cochran-Armitage test supported the trend that perioperative respiratory complications increase with the AHI. Six children developed major respiratory complications, which were not significantly associated with OSA severity.Conclusions: Children with severe OSA have increased risks of perioperative respiratory complications. However, OSA severity does not influence major respiratory complications or postoperative bleeding in children.Level Of Evidence: 4. Laryngoscope, 127:2646-2652, 2017. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relative contributions of obesity and obstructive sleep apnea (OSA) to unfavorable blood pressure in children.Study Design: Children aged 3-18 years with OSA-related symptoms were recruited. All children underwent office blood pressure (BP) monitoring and full-night polysomnography. Obesity was defined as a body mass index ≥95th percentile. OSA severity was divided into primary snoring (apnea-hypopnea index [AHI] <1), mild OSA (5> AHI ≥1), and moderate to severe OSA (AHI ≥5). Age- and sex-adjusted logistic regression analysis was performed to determine the associations among OSA, obesity, and elevated BP.Results: This cross-sectional study enrolled 1689 children (66% boys), with a mean age of 7.9 years. Compared with children with primary snoring, children with moderate to severe OSA had significantly higher systolic BP (108.1 mmHg vs 105.6 mmHg), diastolic BP (75.0 mmHg vs 70.4 mmHg), systolic BP percentile (75.0 vs 70.4), and diastolic BP percentile (74.0 vs 69.2). The rate of unfavorable BP (ie, elevated BP or hypertension level BP) also was significantly higher in children with more severe OSA. Children with obesity had higher BP and BP percentile. Logistic regression analysis revealed that children with obesity and moderate to severe OSA have a 3-fold greater risk of unfavorable BP compared with children without obesity and primary snoring.Conclusions: We identified a 3-fold greater risk of unfavorable BP in children with obesity and moderate to severe OSA. [ABSTRACT FROM AUTHOR]

Background/Purpose: The OSA-18 questionnaire is one of the most widely-used sleep quality measurements in children. We tested the applicability and cross-cultural validation of the traditional Chinese version OSA-18 questionnaire. Methods: This cross-sectional study was conducted in a tertiary medical referral center. The translation and cultural adaptation of the OSA-18 questionnaire were performed based on Brislin's revised model. A total of 109 children aged 2–18 years old with sleep problems were recruited. Overnight polysomnography and the OSA-18 questionnaire were administered. The reliability and validity of the traditional Chinese version of OSA-18 questionnaire were verified. Results: Excellent test–retest reliability and good internal consistency were achieved, and the validity of OSA-18 with overnight polysomnography was confirmed. The domain of sleep disturbance, daytime function, caregiver concerns, and the OSA-18 total scores were significantly higher in sleep apnea patients. The domain of caregiver concern had the highest score, while those of emotional distress had the lowest scores. The optimal cut-off point of the OSA-18 total scores for detecting obstructive sleep apnea was 67. Conclusion: The traditional Chinese version of OSA-18 demonstrated high reliability and good validity in our study. The domain of caregiver concern is the major element in Taiwanese children with sleep-disordered breathing. [ABSTRACT FROM AUTHOR]

Objective: Adenotonsillectomy (T&A) is the first line therapy for pediatric obstructive sleep apnea (OSA); however, inconsistency between objective and subjective outcomes perplexes physicians. This study investigates changes of objective and subjective outcomes in children with OSA after T&A, in particular, to elucidate correlations and discrepancies between these 2 measures.Study Design: Case series with record review.Setting: Tertiary referral medical center.Subjects and Methods: Symptomatic children with polysomnographic diagnosis of OSA (apnea-hypopnea index [AHI] > 1) were included. All children underwent T&A to treat OSA, along with completely objective (polysomnography) and subjective (Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire [OSA-18]) measures before and 3 months after surgery.Results: One hundred nineteen children were included (mean age, 6.9 ± 3.3 years; 76% boys). Adenotonsillectomy significantly reduced AHI from 15.4 ± 21.2 per hour to 1.6 ± 2.5 per hour (P < .001). The OSA-18 scores were significantly improved after surgery (P < .001). A weak but statistically significant positive correlation was found between AHI and OSA-18 scores preoperatively (ρ = 0.22, P = .016) but not postoperatively (ρ = 0.04, P = .677). Among those cases with residual OSA after surgery, only 6% (3/54) had a residual effect on quality of life (OSA-18 score > 60).Conclusion: Adenotonsillectomy improves both objective and subjective outcomes. After surgery, quality of life significantly improved subjectively, despite an incomplete resolution of OSA objectively, leading to a better correlation between objective and subjective measures before as opposed to after surgery. Discrepancy between the 2 measures warrants an evaluation of a child both objectively and subjectively when treating OSA. [ABSTRACT FROM AUTHOR]

Objective: C-reactive protein (CRP) is an important serum marker of inflammation associated with cardiovascular outcomes. This study aims to evaluate the association between CRP and childhood obstructive sleep apnea (OSA) and clarify the effects of adenotonsillectomy on serum CRP levels in children with OSA.Methods: Children with symptoms suggestive of OSA who underwent an overnight polysomnography were recruited from a tertiary medical center. Their serum CRP levels were measured. For children who underwent adenotonsillectomy for OSA treatment, polysomnography and serum high-sensitivity CRP (hs-CRP) level measurement were conducted after surgery.Results: This study included 326 children (mean age: 7.2 ± 3.0 years; boys: 67%). Children with apnea-hypopnea index (AHI) > 5 events/h had significantly higher hs-CRP levels than children with AHI of 1-5 events/h and AHI < 1 event/h [median (interquartile range): 0.08 (0.03-0.25) vs 0.03 (0.02-0.14) vs 0.04 (0.01-0.10), P < 0.001]. Log-transformed hs-CRP levels were positively associated with log AHI values (r = 0.2, P < 0.001). In multiple linear regression analysis, hs-CRP levels were independently associated with AHI; 101 children with OSA (ie, AHI > 1) underwent adenotonsillectomy. In children with OSA in the study cohort, a significant reduction of hs-CRP levels did not occur after surgery [from 0.07 (0.02-0.22) to 0.08 (0.03-0.17), P = 0.716]. In children with OSA having abnormal hs-CRP levels (ie, CRP > 1 mg/dL), hs-CRP levels significantly decreased after surgery [from 1.87 (1.11-2.78) to 0.20 (0.07-1.04), P = 0.043].Conclusion: Children with OSA had increased hs-CRP levels. Children with OSA and abnormal hs-CRP levels exhibited significantly reduced hs-CRP levels following adenotonsillectomy. [ABSTRACT FROM AUTHOR]

Background: The prevalence rate of obstructive sleep apnea (OSA) in the community Down syndrome (DS) children is not clear. Moreover, the impact of OSA and sleep structure on the cognitive function is inconclusive. The present study aimed to investigate 1) the prevalence rate of OSA in the community DS children and 2) the impact of OSA and sleep structure on cognitive performance.Methods: Thirty DS children aged 6-18 years were recruited and evaluated with the performance of the language domain and sensorimotor domain, combining neuropsychological tests and parent-rated behavior. The outcomes were the age-adjusted scores, of which the lower the score was, the better was the patient's ability. The association of score with OSA and sleep structures was determined by linear regression. To diminish the age-related difference, all analyses were conducted separately for all subjects and 6-12-year-old subjects.Results: The median age was 11.3 years and median Full-Scale Intelligence Quotient (FSIQ) was 44. The prevalence of OSA (apnea-hypopnea index ≥ 1/h) was 80% and 62.5% in all subjects and 6-12-year-old subjects, respectively. For 6-12-year-old subjects, after adjustment for age and FSIQ, both %REM and OSA were associated with lower score of the subtest of language domain, WPPSI-R Vocabulary, while %REM was also associated with lower score of VABS-II Communication - Expressive. In contrary, % slow wave sleep was not associated with any subtest.Conclusion: This study identified that OSA may be highly prevalent in community DS children. Among 6-12-year-old DS children, OSA and % REM were associated with their language function. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of adenotonsillectomy (T&A) on ambulatory blood pressure (ABP) in childhood obstructive sleep apnea (OSA).Study Design: From 2012 to 2017, children aged 4-16 years with symptoms and polysomnography-diagnosed OSA (apnea-hypopnea index [AHI] >1) underwent T&A. PSG studies and 24-hour ABP monitoring were performed before and at 3 months after surgery.Results: In total, 159 children were enrolled (mean age, 7.8 ± 3.3 years; 72% male). T&A significantly reduced the AHI from 12.4 ± 15.9 events/hour to 2.7 ± 5.7 events/hour (P < .001). A decrease was observed in the children's overall diastolic blood pressure (65.1 ± 6.1 mm Hg to 63.8 ± 7.4 mm Hg, P = .04) after surgery. In subgroup analysis, 100 (63%) patients were classified as nonhypertensive, and 59 (37%) were classified as hypertensive. Linear mixed model analysis revealed that compared with the children without hypertension, those with hypertension had superior improvement in systolic and diastolic blood pressure during daytime and nighttime (all P values < .01). The ABP changes after surgery were not correlated with the AHI changes. Finally, preoperative hypertension was an independent risk factor of postoperative hypertension among these children (OR 3.66; 95% CI 1.70-7.86).Conclusions: Overall, in children with OSA, the 24-hour ABP change after T&A is small. However, among children with preoperative hypertension, there is significant BP improvement after T&A surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA).Study Design: Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses.Results: In the 163 children enrolled (mean age, 8.2 ± 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables.Conclusions: Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP. [ABSTRACT FROM AUTHOR]

Objective:To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA. Methods:In total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age：toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression. Results:The AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk. Conclusions:Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence. [ABSTRACT FROM AUTHOR]

Objective: Limited information is currently available on 24-h ambulatory blood pressure (ABP) changes after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). In this study, the trajectory of 24-h ABP changes after surgery in children with OSA was examined at three-month and six-month follow-up.Methods: Children aged 4-16 years with clinical symptoms of OSA and polysomnography (PSG)-diagnosed OSA (apnea-hypopnea index [AHI] >1) were included. All the children received T&A. PSG was conducted before and after surgery. Twenty four hour ABP was monitored using the linear mixed model before, three months after, and six months after surgery.Results: In total, 122 children were examined (mean age: 7.9 years; 71% were boys). The AHI significantly decreased from 12.7 ± 16.7 to 2.4 ± 3.2 events/h after T&A (P < 0.001). Overall diastolic blood pressure (DBP; from 65.1 to 63.4 mmHg, P = 0.01) and night-time DBP (from 57.4 to 55.4 mmHg, P = 0.032) decreased nonsignificantly during the six-month postoperative period. The OSA children with presurgical hypertension exhibited significant reductions in overall systolic blood pressure (SBP), overall DBP, daytime DBP, night-time SBP, and night-time DBP at the three-month and six-month postoperative follow-up (all P < 0.05). The three-month and six-month ABP data did not differ significantly in the entire cohort, even between children with presurgical hypertension and non-hypertensive children.Conclusion: The 24-h ABP decreased significantly in the OSA children with hypertension at three and six months after surgery. Moreover, ABP findings did not differ significantly between the three- and six-month follow-up. [ABSTRACT FROM AUTHOR]

To assess the craniofacial morphology in children with sleep-disordered breathing (SDB) using nonradiation and readily accessible photogrammetry technique. Included children aged 3–18 years with SDB-related symptoms from April 2019 to February 2020 in a tertiary center. All participants underwent craniofacial photogrammetry and overnight polysomnography (PSG). Participants were stratified into 2 groups (obstructive sleep apnea [OSA] group: apnea-hypopnea index [AHI] ≥ 1 and non-OSA group: AHI <1). Craniofacial photogrammetry was performed to derive variables of craniofacial features in standardized frontal and profile views. The 2 groups were propensity score matched based on age, sex, and body mass index (BMI) percentiles. Associations between craniofacial feature variables and OSA (AHI ≥1) likelihood were examined using logistic regression test. intraclass correlation coefficient (ICC) was used to evaluate the intrarater and interrater reliability. In total, 58 children were enrolled for the analysis after matching. All 3 variables representing the mandibular plane angle in the profile view were increased in the OSA group (mego-tn: 34.85 ± 5.99 vs 31.65 ± 5.96°, odds ratio [OR]: 1.10, 95% CI:1.02 to 1.18, P =.01; tn-gogn: 28.65 ± 6.38 vs 25.91 ± 5.38°, OR: 1.08, 95% CI:1.02 to 1.15, P =.012; and gome-tsup: 26.71 ± 6.13 vs 22.20 ± 5.89°, OR: 1.13, 95% CI:1.04 to 1.23, P =.003). Craniofacial photogrammetry revealed increased mandibular inclination in children with OSA. A steep mandibular plane with craniofacial photogrammetry is considered a potential predictor of pediatric OSA. Further investigation with a large sample size is required to clarify the validity of photogrammetry in evaluating pediatric OSA. • OSA children present significantly increased mandibular plane angle through photogrammetry. • A steep mandibular plane is considered a characteristic craniofacial morphology in OSA children. • Profile view is easier than frontal view to manifest craniofacial characteristics. • Craniofacial photogrammetry is a novel technique that is easily accessible and radiation free. • For screening of pediatric SDB, craniofacial photogrammetry might be a potential tool readily accessible for clinicians. [ABSTRACT FROM AUTHOR]

Objective To assess how history and/or anatomical findings differ in diagnosing pediatric obstructive sleep apnea (OSA). Methods Children aged 2–18 years were recruited and assessed for anatomical (ie, tonsil size, adenoid size, and obesity) and historical findings (ie, symptoms) using a standard sheet. History and anatomical findings, as well as those measures significantly correlated with OSA, were identified to establish the historical, anatomical, and the combined model. OSA was diagnosed by polysomnography. The effectiveness of those models in detecting OSA was analyzed by model fit, discrimination (C-index), calibration (Hosmer–Lemeshow test), and reclassification properties. Results A total of 222 children were enrolled. The anatomical model included tonsil hypertrophy, adenoid hypertrophy, and obesity, whereas the historical model included snoring frequency, snoring duration, awakening, and breathing pause. The C-index was 0.84 for the combined model, which significantly differed from that in the anatomical (0.78, p  = 0.003) and historical models (0.72, p  < 0.001). The Hosmer–Lemeshow test revealed an adequate fit for all of the models. Additionally, the combined model more accurately reclassified 10.3% ( p  = 0.044) and 21.9% ( p  = 0.003) of all of the subjects than either the anatomical or historical model. Internal validation of the combined model by the bootstrapping method showed a fair model performance. Conclusion Overall performance of combined anatomical and historical findings offers incremental utility in detecting OSA. Results of this study suggest integrating both history and anatomical findings for a screening scheme of pediatric OSA. [ABSTRACT FROM AUTHOR]

Objective To assess short-term and long-term changes in quality of life after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). Materials and methods Children aged 2–18 years old were enrolled. All subjects had clinical symptoms, overnight polysomnography diagnosis of OSA, and received T&A as treatment. Caregivers were asked to complete the OSA-18 survey before surgery, within 6 months after surgery (short-term), and more than 6 months after surgery (long-term). Results A total of 114 children were included (mean age, 7.0 ± 3.5 years; 75% boys). The mean OSA-18 total score was 71.5 ± 16.0 before surgery. After surgery, the mean OSA-18 total score was significantly decreased in both the short-term (40.3 ± 12.2, p < 0.001) and the long-term (42.0 ± 13.7, p < 0.001). All five OSA-18 domains were also significantly decreased during short-term and long-term postoperative follow up ( p < 0.001). Short-term and long-term outcomes were compared. Mean OSA-18 total scores, sleep disturbance score, emotional distress score, daytime function score, and caregiver concerns score did not differ significantly between the short-term and long-term periods, while the physical symptom score was slightly higher in the long-term than the short-term period (9.7 ± 3.3 vs. 8.7 ± 3.0, p = 0.02). Additionally, the physical symptoms score was higher in the long-term period in the female ( p = 0.01), older age (>6 years) ( p = 0.03), and non-obese ( p = 0.04) subgroups. Conclusion T&A improves short-term and long-term quality of life in children with OSA. Nevertheless, caregivers observed children with aggravation of physical symptoms of quality of life during long-term follow up, especially in the female, older, and non-obese subgroups. [ABSTRACT FROM AUTHOR]