Adenoid hypertrophy is directly associated with the severity of OSA in obese children: A pilot study

• Adenoid hypertrophy is intrinsically related to OSA severity in obese children. • DISE should be ideally recommended for children without adenotonsillar hypertrophy. • The parameters in awake and DISE evaluations were equally related to OSA severity. This study aimed to evaluate which physical findings, observed during both awake and DISE examinations, correlate best with polysomnographic severity in obese children with Obstructive Sleep Apnea (OSA). Children diagnosed with pediatric OSA and obesity (BMI > 95th percentile) were evaluated. All underwent polysomnography to confirm the OSA diagnosis. Demographic data, physical exams, and ENT clinical evaluations were also collected. DISE (drug induced sleep endoscopy) was performed just before adenotonsillectomy, following Boudewyns' protocol to assess pharyngeal collapse. Nineteen obese children with OSA were evaluated, with 37% showing adenoid hypertrophy (>75%) on nasal endoscopy, and 53% presented tonsillar hypertrophy on physical examination. The median AHI (apnea / hypopnea index) was 7 (range: 3; 17): 9 had mild, 2 moderate, and 8 severe OSA. Children with adenoid hypertrophy had higher arousal indices, AHI, REM (rapid eye movement) AHI, OAHI (obstructive AHI) and lower minimum saturation compared to those without obstruction, in both awake and DISE evaluations. The presence of other factors, such as tonsillar hypertrophy, tongue base obstruction, palatal and epiglottic collapses, or hypotonia, was not associated with OSA severity or polysomnographic findings in either awake or DISE exams. In our cohort, adenoid hypertrophy was the factor most strongly correlated with OSA severity in obese children. This correlation was consistent between awake physical examination and DISE findings. 3.