Factors associated with chronic and recurrent rhinosinusitis in preschool children with obstructive sleep apnea syndrome

Hyung Ho Yun; Young Min Ahn; Hyun-Jung Kim

doi:10.4168/aard.2018.6.3.168

Journal List > Allergy Asthma Respir Dis > v.6(3) > 1095180

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Yun, Ahn, and Kim: Factors associated with chronic and recurrent rhinosinusitis in preschool children with obstructive sleep apnea syndrome

Original Article

Allergy Asthma Respir Dis 2018;6(3):168-173.

Published online: 5 May 2018

DOI: https://doi.org/10.4168/aard.2018.6.3.168

Factors associated with chronic and recurrent rhinosinusitis in preschool children with obstructive sleep apnea syndrome

Hyung Ho Yun, Young Min Ahn, Hyun-Jung Kim

Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea

Correspondence to: Young Min Ahn https://orcid.org/0000-0002-1697-8041 Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea Tel: +82-2-970-8221, Fax: +82-2-976-5441, E-mail: aym3216@eulji.ac.kr

Received 12 September 201726 October 2017 Accepted 28 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Obstructive sleep apnea syndrome (OSAS) in young children is frequently caused by adenoid and/or tonsillar hypertrophy. Adenoidectomy is the first operative method for childhood chronic rhinosinusitis (CRS). We investigated factors associated with recurrent rhinosinusitis in preschool aged children with OSAS to determine the association of 2 common diseases.

Methods

One hundred forty-six children aged 2–5 years who were diagnosed as having OSAS after polysomnography between December 2003 and April 2016 were enrolled in this study. Children were divided into 2 groups with and without CRS. The 2 groups were compared in the severity of OSAS and allergy diseases and were evaluated for recurrent rhinosinusitis during the follow-up period, 1 year after diagnosis.

Results

Among 108 patients with OSAS who were followed up, 81 patients (75%) were diagnosed with CRS. There were no significant difference clinical and allergic characteristics between groups with and without CRS. However, bronchial asthma and otitis media was significantly more prevalent in patients with CRS than in those without (P=0.045 and P=0.000, respectively). Bronchial asthma and adenotonsillectomy was significantly associated with recurrent rhinosinusitis (P=0.005 and P=0.04, respectively) during the 1-year follow-up.

Conclusion

Approximately 75% of preschool children with OSAS have suffered from CRS. Bronchial asthma is associated with CRS among OSAS children. Recurrent rhinosinusitis is decreased after adenotonsillectomy, and bronchial asthma is an associated factor for recurrent rhinosinusitis after a follow-up. This close relationship childhood OSAS and recurrent rhinosinusitis/bronchial asthma needs further studies to investigate their role in the association.

Keywords: Obstructive sleep apnea, Asthma, Rhinitis, Sinusitis

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Fig. 1.

Linear-by-linear association of chronic rhinosinusitis and recurrent rhinosinusitis in obstructive sleep apnea syndrome according to age. Linear-by-linear association test indicates the prevalence of chronic rhinosinusitis and recurrent rhinosinusitis decreases not significantly as age increases (P for trend=0.051 and P for trend=0.076, respectively). ReRS, recurrent rhinosinusitis; CRS, chronic rhinosinusitis and recurrent rhinosinusitis. Trend in proportions assessed with Linear-by-linear association test.

Fig. 2.

The proportion of chronic rhinosinusitis and recurrent rhinosinusitis in obstructive sleep apnea syndrome by obstructive sleep apnea syndrome severity. The proportion of chronic rhinosinusitis and recurrent rhinosinusitis in obstructive sleep apnea syndrome was not significantly rising trend with increasing obstructive sleep apnea syndrome severity (P for trend=0.292 and P for trend=0.480, respectively). CRS, chronic rhinosinusitis and recurrent rhinosinusitis; ReRS, recurrent rhinosinusitis; OSAS, obstructive sleep apnea syndrome. Trend in proportions assessed with Linear-by-linear association test.

Table 1.

Clinical characteristics of children with and without CRS

Characteristic	CRS (n=81)	Without CRS (n=27)	P-value
Male sex	58 (71.6)	19 (70.3)	0.902
Age (yr)	3.42±1.105	3.89±0.93	0.170
BMI (kg/m²)	15.99±1.82	16.32±2.01	0.712
AHI (event/hr)	6.69±10.82	3.68±4.97	0.040
Otitis media	67 (82.7)	7 (25.9)	0.000
Allergy disease
AR	55 (67.9)	18 (66.7)	0.906
BA	42 (51.9)	8 (29.6)	0.045
AD	31 (38.3)	7 (25.9)	0.245
Skin prick test
House dust mite	45 (55.6)	13 (48.1)	0.504
Animal dander	24 (29.6)	3 (11.1)	0.054
Pollens	20 (24.7)	3 (11.1)	0.136
Total IgE (IU/mL)	138±189.47	78.91±158.78	0.158
Eosinophil (%)	2.78±1.89	2.64±2.59	0.064

Values are presented as number (%) or mean±standard deviation.

CRS, chronic rhinosinusitis and recurrent rhinosinusitis; BMI, body mass index; AHI, apnea-hyponea index; AR, allergic rhinitis; BA, bronchial asthma; AD, atopic dermatitis.

Table 2.

Comparison of associated factors between with and without ReRS

Variable	ReRS (n=34)	Without ReRS (n=74)	P-value
AR	14 (41.2)	21 (28.4)	0.187
BA	14 (41.2)	12 (16.2)	0.005
AD	5 (14.7)	11 (14.9)	0.983
OM	12 (35.3)	21 (28.4)	0.469
AT	13 (38.2)	44 (59.5)	0.040

Values are presented as number (%).

ReRS, recurrent rhinosinusitis; AR, allergic rhinitis; BA, bronchial asthma; AD, atopic dermatitis; OM, otitis media; AT, adenotonsillectomy.

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