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Association of palatine tonsil size and obstructive sleep apnea in adults
Open accessAbstract
Objective: The relationship between palatine tonsil (PT) size and obstructive sleep apnea (OSA) has not been well established in adults. The purpose of this study was to test the association between PT grade, PT volume, and OSA severity in U.S. adult patients. Study Design: Cross‐sectional study of all patients (age ≥ 18 years) who underwent pharyngeal surgery for OSA that included palatine tonsillectomy with tonsil volume measurement from January 2011 to June 2016. Methods: Medical records were reviewed for PT grade (measured on clinical exam by the Brodsky tonsil grading scale), PT volume (measured intraoperatively by water displacement), and apnea–hypopnea index (AHI). Associations were evaluated with multivariate linear regression adjusting for age, sex, body mass index (BMI), smoking status, lingual tonsil volume (AHI models only), and multilevel surgery aside from lingual tonsillectomy (PT volume vs. AHI model only). Results: The cohort (N = 83) was middle‐aged (mean age 43 ± 12 years), predominantly male (61%), obese (mean BMI 33 ± 7 kg/m 2), and had severe OSA (mean AHI 32 ± 28). After adjustment for confounders, PT grade was strongly associated with PT volume (beta = 1.8, 95% confidence interval [CI]: [1.0, 2.6], P < 0.001) and with AHI (beta = 13.5, 95% CI: [3.5, 23.6], P = 0.01); PT volume was not associated with AHI (beta = −0.2, 95% CI: [−2.2, 1.9], P = 0.89). Conclusion: In contrast to past studies, subjective PT grade (vs. objective PT volume) was more strongly associated with AHI. These data suggest the space that the tonsils occupy within the oropharyngeal airway, instead of their actual measured volume, may be more predictive of OSA severity in a cohort of U.S. adult patients. Level of Evidence: 2c. Laryngoscope, 128:1002–1006, 2018
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Increasing tonsil grade is significantly associated with increasing OSA severity, with each increase in Brodsky grade correlating to an increase in AHI of approximately 14 events/h.
“The most recent study by Jara and Weaver studied an adult heterogeneous OSA population in the US and found that increasing tonsil grade was significantly associated with increasing OSA severity with adjusted data showing that every increase in tonsil grade as measured by the Brodsky classification system correlated to an increase in AHI of approximately 14 events/h.327”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [327]
Tonsil grade is more predictive of OSA than tonsil volume, indicating that the proportion of space occupied within the oropharynx may be more important than actual tonsil volume.
“They also found that tonsil grade was more predictive of OSA than tonsil volume indicating that the actual tonsil volume may be less important than the proportion of space occupied within the OP.327”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [327]
Each increase in tonsillar size correlates to an increase in AHI of approximately 14 events/h in adults with OSA.
“Tonsil size may predict severity of OSA, and a study of adults with OSA demonstrated that each increase in tonsillar size correlates to an increase in AHI of approximately 14 events/h.327”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [327]
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References 17 · Cited by 41
Metadata
- Authors
- Jara, S. M., & Weaver, E. M.
- Affiliations
- University of Washington (US)
- Corresponding author
- Jara, Sebastian M.
- Venue
- The Laryngoscope
- Publisher
- Wiley
- Published
- 2017-12-05
- Volume
- 128
- Issue
- 4
- Pages
- 1002-1006
- ISSN
- 0023-852X (ISSN-L)
- 1531-4995
- PMC
- PMC5867223
- OpenAlex
- W2774759554
- Cited by
- 41
- References
- 17
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 3 · 2020: 6 · 2019: 4 · 2018: 1
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Laryngoscope (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (T32 DC000018, F32 HL136004)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Otorhinolaryngology › Oropharyngeal Anatomy and Pathologies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, apnea-hypopnea index, OSA severity, oropharyngeal airway, palatine tonsillectomy, water displacement measurement, adults
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Hypertrophy, Male, Organ Size, Palatine Tonsil, Tonsillectomy, Body Mass Index, Polysomnography, Sleep Apnea, Obstructive
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