Ethnicity was a significant factor with more obese ATSI children having OSA. The significant correlation between hs-CRP with OEI is consistent with findings of previous studies. Several factors (glycosylated haemoglobin, LDL) approached significance.
have been a neck-to-waist circumference ratio, which is also a measure of body fat distribution. A study of children between 7 and 18 years old with OSA 3 showed that neck-to-waist ratio predicts OSA in obese and overweight older children. This study was initiated on the background knowledge that central adiposity and large neck circumference are known to be associated with OSA in adults. Third, there are no obesity clinics such as Kinder Overweight Activity Lifestyle Actions (KOALA) for children in most rural and regional areas in Australia making the management of obesity in children particularly difficult and further disadvantaging ATSI and widening the gap in access to health services. Some tertiary level obesity services could be made available to children in regional areas via telehealth links with travel reserved for detailed polysomnography and/or ear, nose and throat (ENT) procedures.The finding that ethnicity might be a significant factor for the development of OSA raises concerns for hundreds of obese ATSI children in rural and remote areas who have limited access to detailed polysomnography, sleep clinics and Ear Nose and Throat services. I agree that clinicians need to have a low threshold in investigating and referring obese ATSI children for OSA. Our study showed that ethnicity was statistically significant: of the six Aboriginal and Torres Strait Islander (ATSI) children, three children had severe OSA while the other three had mild-moderate OSA. The children with severe OSA had polysomnography within 3 to 12 months of referral. Five of the ATSI children were from South East Queensland and one from Northern New South Wales.As Dr Banda has pointed out, only one of six Pacific Islander/ Maori children had OSA (which was mild). Our study had a small sample size and was possibly not powered enough to detect the previously identified relationships between Pacific Islander/Maori ethnicity and OSA in adult men. We are not aware of any similar studies conducted in Australia looking into OSA in this paediatric population.We are aware of the Canadian study that Dr Banda referenced, which looked at neck-to-waist ratios being predictive of OSA in children with obesity. Our study was retrospective, and these data were not recorded. Prospective studies in Australia will be useful.Despite being a small retrospective study, our results may be relevant. Assessment and management of all children with obesity and possible OSA, including ATSI children, needs to be supported in rural and remote areas. We acknowledge that rural health services in most, if not all, rural and regional areas of Australia lack multidisciplinary clinical teams for overweight and obese children. Even tertiary paediatric centres have, until recently, had no or limited clinical services for obese children, especially those from lower socio-economic areas. 3Until an adequately funded co-ordinated national approach is adopted addressing community prevention, as well as primary and tertiary care management of childhood and adolescent obesity, and...
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