Upper airway lymphoid tissue size in children with sickle cell disease

Temima Strauss, Sanghun Sin, Carole L. Marcus, Thornton B.A. Mason, Joseph M. McDonough, Julian L. Allen, Jason B. Caboot, Cheryl Y. Bowdre, Abbas F. Jawad, Kim Smith-Whitley, Kwaku Ohene-Frempong, Allan I. Pack, Raanan Arens

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Background: The prevalence of obstructive sleep apnea syndrome (OSAS) is higher in children with sickle cell disease (SCD) as compared with the general pediatric population. It has been speculated that overgrowth of the adenoid and tonsils is an important contributor. Methods: The current study used MRI to evaluate such an association. We studied 36 subjects with SCD (aged 6.9 ± 4.3 years) and 36 control subjects (aged 6.6 ± 3.4 years). Results: Compared with control subjects, children with SCD had a significantly smaller upper airway (2.8 ± 1.2 cm3 vs 3.7 ± 1.6 cm 3, P<.01), and significantly larger adenoid (8.4 ± 4.1 cm3 vs 6.0 ± 2.2 cm3, P<.01), tonsils (7.0 ± 4.3 cm3 vs 5.1 ± 1.9 cm3, P<.01), retropharyngeal nodes (3.0 ± 1.9 cm3 vs 2.2 ± 0.9 cm3, P<.05), and deep cervical nodes (15.7 ± 5.7 cm 3 vs 12.7 ± 4.0 cm3, P<.05). Polysomnography showed that 19.4% (seven of 36) of children with SCD had OSAS compared with 0% (zero of 20) of control subjects (P<.05) and that in children with SCD the apnea-hypopnea index correlated positively with upper airway lymphoid tissues size (r = 0.57, P< 001). In addition, children with SCD had lower arterial oxygen saturation nadir (84.3% ± 12.3% vs 91.2% ± 4.2%, P<.05), increased peak end-tidal CO2 (53.4 ± 8.5 mm Hg vs 42.3 ± 5.3 mm Hg, P<.001), and increased arousals (13.7 ± 4.7 events/h vs 10.8 ± 3.8 events/h, P<.05). Conclusions: Children with SCD have reduced upper airway size due to overgrowth of the surrounding lymphoid tissues, which may explain their predisposition to OSAS.

Original languageEnglish (US)
Pages (from-to)94-100
Number of pages7
Issue number1
StatePublished - Jul 2012

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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