Objective: Obstructive Sleep Apnea (OSA) is a common sleep-disordered breathing condition in children. Moderate/severe OSA can lead to a series of complications, including growth restriction and neurocognitive impairment, severely impacting children’s physical and mental health. The gold standard for diagnosing OSA is polysomnography (PSG). Given the limitations of PSG in large-scale screening and the insufficient accuracy and compliance of existing screening tools, exploring simple and reliable screening tools for moderate/severe OSA holds significant clinical importance. This study aims to systematically compare the predictive efficacy of neck-to-height ratio (NHR), waist-to-height ratio (WHtR), hip-to-height ratio (HHR), and BMI Z-score for moderate/severe pediatric OSA, providing more accurate and convenient indicators for clinical screening. Methods: We retrospectively analyzed data from 685 children aged 3– 16 years who underwent PSG. Using age, gender, tonsil size, and adenoid size as covariates, receiver operating characteristic (ROC) analysis was used to assess the discriminatory ability of NHR, WHtR, HHR, and BMI Z-score in the overall cohort and within age and gender subgroups. Results: NHR demonstrated the highest predictive efficacy in the overall cohort (AUC=0.781), significantly outperforming other indices. Subgroup analysis revealed that NHR maintained excellent predictive performance in children above 10 years, with AUC values of 0.777 in boys and 0.913 in girls. Conclusion: The NHR may serve as a useful adjunctive screening tool for moderate/severe OSA in children above 10 years, showing moderate predictive value and outperforming traditional indices such as WHtR, HHR, and BMI Z-score. Keywords: neck-to-height ratio, obstructive sleep apnea, children, anthropometric indices, polysomnography
Liu et al. (2026) studied this question.