Obstructive sleep apnea (OSA) in children is a common clinical problem that causes obstruction to breathing during sleep. Affecting one in ten children, the growing prevalence of this problem has attracted national attention. The hallmark of OSA is snoring, which is a sign of resistance to airflow. The definitive test for OSA is polysomnography, also termed a sleep study.

Fig. 1. Summary of results. In this figure, the relationship between age and OSA severity is shown as a function of body weight. While the green line, representing children with normal body weight, illustrates a declining trend in OSA severity with age, children with severe obesity (red line) displayed a heightened risk of worsening OSA over time.

Previous studies have shown that most children with OSA may be cured by removing their tonsils and adenoids (tonsillectomy and adenoidectomy), which are the most likely sites of airway obstruction in healthy children with a normal body weight. Unfortunately, the growing epidemic of childhood obesity has potential to complicate the treatment of OSA. Where obstruction was mostly the result of enlarged tonsil and adenoid tissue alone, obesity introduces additional narrowing of the airway. Thus, although tonsillectomy and adenoidectomy still provides significant benefit in these children, the success rates are not as striking as in children with normal body weight. In addition, age also plays a role as airway dimensions change constantly as a result of growth and development.

In order to explain the relationship between body weight and severity of sleep apnea, Scott et al. (2016) investigated a group of children between the ages of 2 and 18 who underwent a sleep study to determine the severity of OSA. These children were then categorized as normal weight, overweight, obese, or morbidly obese. The severity of sleep apnea is gauged by apnea-hypopnea index (AHI), a measurement representing the number of episodes of airway obstruction per hour of sleep.

The authors highlight a complex relationship between OSA severity and body weight. The study illustrated that the most affected children are likely to be both older and obese. Not surprisingly, the quality of sleep as well as its structure were also altered in obese children. Obese children spent less time in restorative sleep.

This study emphasizes a number of important issues. First, despite the complexity of interaction between age and body weight, older obese children were likely to have the most severe degree of sleep apnea. Next, notwithstanding the degree of airway obstruction seen in obese children, both structure and quality of sleep were affected in these children. The lack of restful sleep in these children may be particularly detrimental to learning and overall brain development. Surprisingly, the most reassuring finding from the study is the overall trend towards resolution of OSA in children with normal body weight, over time.

Amal Isaiah, Ron B. Mitchell
Department of Otolaryngology–Head and Neck Surgery,
UT Southwestern Medical Center and Children’s Health, Dallas, TX, USA

Publication

Obstructive Sleep Apnea: Differences between Normal-Weight, Overweight, Obese, and Morbidly Obese Children.
Scott B, Johnson RF, Mitchell Md RB
Otolaryngol Head Neck Surg. 2016 May

Read offline:     

Related Articles:

	A novel measure for predicting OSA whilst awake Obstructive sleep apnea (OSA) is a common sleep disorder, and its prevalence increases significantly with age. Despite being massively under-diagnosed, the latest estimation of OSA prevalence is >1 billion globally.…
	Campylobacter antimicrobial resistance in dogs and humans Campylobacteriosis has been the most frequently reported zoonotic disease in humans in Europe since 2005, and the annual number of notified   campylobacteriosis   cases   has   increased in   many   European countries in…
	Short sleep duration is associated with symptoms of… The average person spends about a third of his life sleeping, but for the busy and the ambitious that is a lot of time.  Many of us would rather spend…
	Chronic cough cured by proxy Chronic cough causes a severe burden on an individual’s quality of life. Habit cough is a chronic functional cough, meaning it has no physical basis. Habit cough is identified as…
	The algal organic matter: A novel carbon source to enhance… In recent years, nitrogen pollution, especially nitrate is an important problem faced by lots of reservoirs. Excessive nitrogen levels can cause water eutrophication, resulting in deterioration of water quality by…
	Small waterbodies as indicators of elemental pollution in… The impact of urbanization and industrialization on sediment quality of large rivers and lakes have been widely studied globally, however, small waterbodies, such as ponds and canals, are rarely studied…