Clinical predictors of obstructive sleep apnea severity in preschool children

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Created On: 09/10/2026

Obstructive sleep apnea (OSA) in preschool children is commonly associated with upper-airway obstruction, particularly from enlarged adenoids and tonsils.

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Key take away

Allergic rhinitis shows a stronger independent association with pediatric obstructive sleep apnea severity than adenoid enlargement.

Background

Obstructive sleep apnea (OSA) in preschool children is commonly associated with upper-airway obstruction, particularly from enlarged adenoids and tonsils. Allergic rhinitis (AR) can also contribute to nasal obstruction and impaired airway function, but its independent contribution to OSA severity remains less clearly defined when adenotonsillar anatomy and other clinical factors are considered. The study aimed to compare the independent contributions of AR, adenoid hypertrophy (AH), and tonsil enlargement to OSA severity in preschool children and identify the strongest independent predictor.

Method

This study evaluated a cohort of 177 pediatric patients aged 3 to 6 years. Participants were stratified into four distinct cohort categories based on endoscopic adenoid assessment (nasal endoscopic obstruction >75%) and AR status (confirmed via serum total immunoglobulin E [IgE], inhalant-specific IgE testing, or established clinical criteria):

Group A (AH alone, n = 39): Significant adenoid obstruction without allergic sensitization.
Group B (Mixed factors, n = 63): Combined presence of AH and AR.
Group C (AR alone, n = 53): Confirmed AR without significant adenoid obstruction.
Group D (Control group, n = 22): Absence of significant AH or AR.

OSA severity was assessed using the apnea-hypopnea index (AHI) from polysomnography. Kruskal-Wallis, Spearman correlation, and multivariate regression analyses were performed to assess group differences, the IgE–AHI relationship, and independent predictors of natural log-transformed AHI (ln_AHI).

Result

Combined Pathology Yields Highest Severity: Children presenting with combined AH and AR (Group B) exhibited significantly higher AHI scores than other groups.
Serological Correlation: Total serum IgE illustrated a statistically significant, albeit weak, positive linear correlation with nocturnal AHI (rs = 0.15).
Multivariate Predictors of Severity: Multivariate linear regression identified AR as the most potent independent predictor of ln_AHI (standardized beta = 0.258).
Hierarchy of Predictors: The relative predictive strength for OSA severity was ordered as follows: Allergic rhinitis → Tonsil size → Body mass index (BMI) → Adenoid size → Gender
Age: It did not reach statistical significance as an independent predictor in this age cohort.

Conclusion

AR emerged as the strongest independent predictor of OSA severity in preschool children, followed by tonsil size, BMI, and adenoid size. The findings highlight the importance of assessing allergic status alongside adenotonsillar anatomy when evaluating pediatric OSA.