Predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of obstructive sleep apnea in pediatric population

TL;DR

This study shows that the Mallampati score, tonsillar size, and BMI z-score can help predict the presence and severity of obstructive sleep apnea in children.

Contribution

The study identifies combined predictive value of Mallampati score and BMI z-score for OSA presence and individual predictive roles for OSA severity.

Findings

OSA frequency and severity were highest in children with high Mallampati score and obesity.

Mallampati score and BMI z-score are significant predictors of OSA presence.

Mallampati score, tonsillar size, and BMI z-score predict OSA severity.

Abstract

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder in children. Determination of risk factors for the development of OSA is essential for early diagnosis and treatment of the disease and decreases the risk of negative consequences. This study aimed to investigate the predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of OSA in children.

This prospective cross-sectional study included 114 children with OSA symptoms. All children were assessed by BMI z-score, Mallampati score, and tonsillar size and underwent overnight polysomnography. They were consecutively selected and assigned to 4 groups as follows: Group 1 included normal-weight with a low Mallampati score; Group 2 involved normal-weight with a high Mallampati score; Group 3 included obese with a low Mallampati score; and Group 4 involved obese with a high Mallampati score.

Of the 114 included children, 58 were female and 56 were male, with a mean age of 13.1 ± 2.9 years. OSA frequency and apnea-hypopnea index were significantly higher in group 4 compared with other groups (p = 0.003 and p < 0.0001, respectively), whereas average and minimum spO2 were significantly lower (for both, p = 0.001). Mallampati score and BMI z-score were found to be significant for predicting OSA (odds ratio = 4.147, 95% CI: 1.440–11.944; p = 0.008 and odds ratio = 1.760, 95% CI: 1.039–2.980; p = 0.035, respectively). Among OSA patients, the Mallampati score, tonsillar size, and BMI z-score were found to be significant for predicting OSA severity (odds ratio = 4.520, 95% CI: 1.332–15.335, p = 0.015, odds ratio = 9.177, 95% CI: 2.513–33.514, p = 0.001, and odds ratio = 2.820, 95% CI: 1.444–5.508; p = 0.002, respectively).

The coexistence of the Mallampati score and BMI z-score significantly increases the presence of OSA in children. Mallampati score, tonsillar size, and BMI z-score are promising parameters for predicting OSA severity.

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