The level of significance was set at 5% (p < 0.05). A total of 85 patients were evaluated, of whom 58.8% were males. Regarding ethnicity, 71.8% self-reported as mixed-race, 20% as black, and 8.2% as white. Table 1 shows the clinical profile of children and adolescents with SCA. There was no statistically significant Fulvestrant difference between the mean ages, as it was 9 ± 4 years in the apneic group and 9 ± 3 years in the non-apneic group. The classification of pharyngeal and palatine tonsils in this sample, as well

as their frequencies, are described by Salles et al.5 The distribution of polysomnographic data is shown in Table 2. There was no association between OSAS and the variables: ethnicity, gender, age, BMI Z-score, and height/age Z-score. Of the 85 patients who were submitted to polysomnography, only nine had AHI ≥ 1 (events per hour of sleep), characterizing OSAS. Nocturnal desaturation was observed in 69 patients (81.2%), as reported in a previous study.12 The number of events per hour of sleep showed a mean of 13, ranging from 1.5 to 29 in the group of patients with apnea, and a mean of five, ranging from one to 11 events per hour of sleep in the non-apneic group.12 Table

3 shows the association between nocturnal desaturation and CC and AC, as well as maxillary and mandibular measurements. In this sample, measurements of CC and AC, as well as maxillary, mandibular, and overjet measurements were correlated with nocturnal desaturation values obtained during the polysomnography Lck using Spearman’s test (Table 4). The positive correlation between height/age Z-score and CC observed Crenolanib research buy in the present study is in agreement with the literature, since studies have demonstrated that sickle-cell anemia patients younger than 18 have height deficit, when compared to normal children;13 and 14 the growth curve alterations in these children may be associated with UA obstruction and obstructive events during sleep, and, consequently, with the decrease in growth hormone release.15 Bar et al.16

compared the insulin-like growth factor I in children with UA obstruction due to ATH, before and after submitting them to adenotonsillectomy. Prior to surgery, insulin-like growth factor I showed a mean value of 146.3 ng/mL and after surgery, it increased to 210.3 ng/mL (p < 0.01), while the disordered breathing index was within the normal range. In the present study, nocturnal desaturation in children and adolescents with SCA was associated with CC. One of the key structures for breathing is the laryngeal tract, which is located in the cervical region and, in the child, is shaped like a funnel, narrowing from the vocal folds to the subglottic region.17 As the child grows, there is an expansion of the subglottic area,15 and the thyroid cartilage, which appears adjacent to the hyoid bone at birth, will move away from the latter in the craniocaudal direction.