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. 2003 Dec;88(12):1043–1047. doi: 10.1136/adc.88.12.1043

A controlled study of sleep related disordered breathing in obese children

Y Wing 1, S Hui 1, W Pak 1, C Ho 1, A Cheung 1, A Li 1, T Fok 1
PMCID: PMC1719407  PMID: 14670764

Abstract

Background: Unlike the adult sleep related disordered breathing (SDB) patients who are typically obese, the relation between obesity and childhood SDB is not clear.

Aims: To investigate whether obese children are more at risk of obstructive SDB when compared to normal population, and whether this risk is potentiated by the presence of pharyngeal lymphoid tissue.

Methods: Forty six obese children (age 10.8 (SD 2.3) years; BMI 27.4 (SD 5.1)), and 44 sex and age matched normal weight children (age 11.7 (SD 2.1) years; BMI 18 (SD 1.8)) were studied. All children underwent a set of physical examinations (including the upper airways) and sleep studies.

Results: The obese children were different from the normal weight children in terms of type (predominantly obstructive), frequency, and severity of respiratory disturbances. Depending on the criteria used, 26% or 32.6% of obese children had SDB; 2.3% of normal controls had OAI ⩾1 and 4.5% had RDI ⩾5. Presence of SDB was related to presence of tonsils (size >2; range 0–4) (OR 12.67, 95% CI 2.14 to 75.17) and BMI (OR 1.20, 95% CI 1.08 to 1.33).

Conclusions: Results suggest that obese children are at increased risk of obstructive SDB; the presence of any pharyngeal lymphoid tissue enlargement in obese children should therefore be aggressively managed.

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Selected References

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  1. Ali N. J., Pitson D. J., Stradling J. R. Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child. 1993 Mar;68(3):360–366. doi: 10.1136/adc.68.3.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brander P. E., Mortimore I. L., Douglas N. J. Effect of obesity and erect/supine posture on lateral cephalometry: relationship to sleep-disordered breathing. Eur Respir J. 1999 Feb;13(2):398–402. doi: 10.1183/09031936.99.13239899. [DOI] [PubMed] [Google Scholar]
  3. Brooks L. J., Stephens B. M., Bacevice A. M. Adenoid size is related to severity but not the number of episodes of obstructive apnea in children. J Pediatr. 1998 Apr;132(4):682–686. doi: 10.1016/s0022-3476(98)70360-9. [DOI] [PubMed] [Google Scholar]
  4. Brouillette R. T., Fernbach S. K., Hunt C. E. Obstructive sleep apnea in infants and children. J Pediatr. 1982 Jan;100(1):31–40. doi: 10.1016/s0022-3476(82)80231-x. [DOI] [PubMed] [Google Scholar]
  5. Chay O. M., Goh A., Abisheganaden J., Tang J., Lim W. H., Chan Y. H., Wee M. K., Johan A., John A. B., Cheng H. K. Obstructive sleep apnea syndrome in obese Singapore children. Pediatr Pulmonol. 2000 Apr;29(4):284–290. doi: 10.1002/(sici)1099-0496(200004)29:4<284::aid-ppul8>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  6. Gaultier C. Sleep-related breathing disorders. 6. Obstructive sleep apnoea syndrome in infants and children: established facts and unsettled issues. Thorax. 1995 Nov;50(11):1204–1210. doi: 10.1136/thx.50.11.1204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goh D. Y., Galster P., Marcus C. L. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):682–686. doi: 10.1164/ajrccm.162.2.9908058. [DOI] [PubMed] [Google Scholar]
  8. Gold A. R., Schwartz A. R., Wise R. A., Smith P. L. Pulmonary function and respiratory chemosensitivity in moderately obese patients with sleep apnea. Chest. 1993 May;103(5):1325–1329. doi: 10.1378/chest.103.5.1325. [DOI] [PubMed] [Google Scholar]
  9. Gortmaker S. L., Dietz W. H., Jr, Sobol A. M., Wehler C. A. Increasing pediatric obesity in the United States. Am J Dis Child. 1987 May;141(5):535–540. doi: 10.1001/archpedi.1987.04460050077035. [DOI] [PubMed] [Google Scholar]
  10. Hui S., Wing Y. W. Obstructive sleep apnoea syndrome in children. Hong Kong Med J. 1997 Dec;3(4):419–426. [PubMed] [Google Scholar]
  11. Leach J., Olson J., Hermann J., Manning S. Polysomnographic and clinical findings in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 1992 Jul;118(7):741–744. doi: 10.1001/archotol.1992.01880070071013. [DOI] [PubMed] [Google Scholar]
  12. Leung S. S., Lau J. T., Tse L. Y., Oppenheimer S. J. Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years. J Paediatr Child Health. 1996 Apr;32(2):103–109. doi: 10.1111/j.1440-1754.1996.tb00904.x. [DOI] [PubMed] [Google Scholar]
  13. Mallory G. B., Jr, Fiser D. H., Jackson R. Sleep-associated breathing disorders in morbidly obese children and adolescents. J Pediatr. 1989 Dec;115(6):892–897. doi: 10.1016/s0022-3476(89)80738-3. [DOI] [PubMed] [Google Scholar]
  14. Marcus C. L., Hamer A., Loughlin G. M. Natural history of primary snoring in children. Pediatr Pulmonol. 1998 Jul;26(1):6–11. doi: 10.1002/(sici)1099-0496(199807)26:1<6::aid-ppul3>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  15. Marcus C. L., Omlin K. J., Basinki D. J., Bailey S. L., Rachal A. B., Von Pechmann W. S., Keens T. G., Ward S. L. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis. 1992 Nov;146(5 Pt 1):1235–1239. doi: 10.1164/ajrccm/146.5_Pt_1.1235. [DOI] [PubMed] [Google Scholar]
  16. Marcus C. L. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol. 2000 Feb;119(2-3):143–154. doi: 10.1016/s0034-5687(99)00109-7. [DOI] [PubMed] [Google Scholar]
  17. McNamara F., Issa F. G., Sullivan C. E. Arousal pattern following central and obstructive breathing abnormalities in infants and children. J Appl Physiol (1985) 1996 Dec;81(6):2651–2657. doi: 10.1152/jappl.1996.81.6.2651. [DOI] [PubMed] [Google Scholar]
  18. Redline S., Tishler P. V., Schluchter M., Aylor J., Clark K., Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1527–1532. doi: 10.1164/ajrccm.159.5.9809079. [DOI] [PubMed] [Google Scholar]
  19. Reilly J. J., Dorosty A. R., Emmett P. M. Prevalence of overweight and obesity in British children: cohort study. BMJ. 1999 Oct 16;319(7216):1039–1039. doi: 10.1136/bmj.319.7216.1039. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rhodes S. K., Shimoda K. C., Waid L. R., O'Neil P. M., Oexmann M. J., Collop N. A., Willi S. M. Neurocognitive deficits in morbidly obese children with obstructive sleep apnea. J Pediatr. 1995 Nov;127(5):741–744. doi: 10.1016/s0022-3476(95)70164-8. [DOI] [PubMed] [Google Scholar]
  21. Rona R. J., Li L., Gulliford M. C., Chinn S. Disturbed sleep: effects of sociocultural factors and illness. Arch Dis Child. 1998 Jan;78(1):20–25. doi: 10.1136/adc.78.1.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rosen C. L. Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol. 1999 Jun;27(6):403–409. doi: 10.1002/(sici)1099-0496(199906)27:6<403::aid-ppul7>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  23. Rosen C. L. Obstructive sleep apnea syndrome (OSAS) in children: diagnostic challenges. Sleep. 1996 Dec;19(10 Suppl):S274–S277. [PubMed] [Google Scholar]
  24. Silvestri J. M., Weese-Mayer D. E., Bass M. T., Kenny A. S., Hauptman S. A., Pearsall S. M. Polysomnography in obese children with a history of sleep-associated breathing disorders. Pediatr Pulmonol. 1993 Aug;16(2):124–129. doi: 10.1002/ppul.1950160208. [DOI] [PubMed] [Google Scholar]
  25. Stradling J. R., Thomas G., Warley A. R., Williams P., Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990 Feb 3;335(8684):249–253. doi: 10.1016/0140-6736(90)90068-g. [DOI] [PubMed] [Google Scholar]
  26. Thorpy M. J. The clinical use of the Multiple Sleep Latency Test. The Standards of Practice Committee of the American Sleep Disorders Association. Sleep. 1992 Jun;15(3):268–276. doi: 10.1093/sleep/15.3.268. [DOI] [PubMed] [Google Scholar]
  27. Troiano R. P., Flegal K. M. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics. 1998 Mar;101(3 Pt 2):497–504. [PubMed] [Google Scholar]
  28. Unger R., Kreeger L., Christoffel K. K. Childhood obesity. Medical and familial correlates and age of onset. Clin Pediatr (Phila) 1990 Jul;29(7):368–373. doi: 10.1177/000992289002900701. [DOI] [PubMed] [Google Scholar]
  29. Watanabe Toshihide, Isono Shiroh, Tanaka Atsuko, Tanzawa Hideki, Nishino Takashi. Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. Am J Respir Crit Care Med. 2002 Jan 15;165(2):260–265. doi: 10.1164/ajrccm.165.2.2009032. [DOI] [PubMed] [Google Scholar]

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