| Summary: | We read with great interest the article
entitled “Neck circumference
as a useful marker for screening
overweight and obesity in
children and adolescents” published in the May
issue of the Oman Medical Journal.1 The article
highlights the worrying issue of overweight and
obesity among children and adolescents including
those in developing countries.2 The predisposing
factors for such an unhealthy body figure include the
consumption of readily available fast food, processed
food, and fizzy drinks. Physical activity in childhood
is largely getting replaced by handheld electronic
games further accentuating the problem.
Obesity is closely related to many chronic
illnesses, mainly metabolic diseases such as
diabetes, hyperlipidemia, hypercholesterolemia,
and metabolic syndromes. As clearly stated in the
article, neck circumference has been identified to
be an important screening tool for overweight and
obesity.1 Indirectly, neck circumference is also used
for the assessment of cardiovascular risk factors in
children.3
In otolaryngology practice, neck circumference
is an important tool for predicting obstructive sleep
apnea. In fact, neck circumference corrected for
height is more useful as a predictor for obstructive
sleep apnea than general obesity.4 Some researchers
have gone further with this input estimating the
neck circumference by using the easy sleep apnea
predictor (ESAP). Patients are asked to place their
thumbs together at the anterior neck, and to wrap
their fingers around their neck until they meet in the
posterior part. If the patient can encircle the neck
completely without excess squeezing and choking,
it is considered a negative ESAP test.5 On the
other hand, in cases where a patient has an Apnea-
Hypopnea Index (AHI; used to indicate the severity
of sleep apnea) score of more than five, a positive
ESAP has a predictive power of 100%. However, a
negative ESAP test in these cases has a predictive
power of 31%. The sensitivity and specificity of
ESAP were 68.3% and 100%, respectively.
In conclusion, neck circumference is an easy
clinical examination tool not only for screening
overweight and obesity in the pediatric population
and predicting the risk of metabolic syndromes, but
also to predict obstructive sleep apnea.
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